CPT 72148Radiology

Mri lumbar spine w/o dye

CPT code 72148 is used when a patient receives an MRI scan of their lower back (lumbar spine) without using contrast dye or injectable material.

Showing rates for

National Average

Base Medicare rate

$188.26

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.48

PE RVU (NF)

4.25

MP RVU

0.09

Total RVU

5.82

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always verify prior authorization before scheduling - most commercial payers require pre-authorization for MRI studies including 72148
Impact: Prevents 100% denial for lack of authorization, saving $188.26 Medicare or higher commercial rates ($300-$600 typical)
Document specific clinical indication and failed conservative therapy - payers increasingly require documentation of 4-6 weeks of conservative treatment before approving MRI
Impact: Reduces medical necessity denials by approximately 35-40%, particularly important for commercial payers with stricter policies than Medicare
Bill technical and professional components separately when services are split between facilities - use modifier TC for facility and 26 for reading physician
Impact: Ensures both entities receive appropriate payment; prevents overpayment recovery audits that can result in full claim recoupment
Do not bundle with 72146 (MRI lumbar with contrast) or 72158 (MRI lumbar without then with contrast) - these are mutually exclusive codes
Impact: Prevents automatic denial and potential fraud investigation; use only the code that accurately describes the actual service performed
Ensure medical necessity ICD-10 codes are specific - avoid using unspecified back pain codes like M54.5 without additional detail
Impact: Reduces medical necessity denials by 20-25%; specific codes like M51.26 (lumbar disc displacement with radiculopathy) have higher approval rates
Submit exam with complete radiologist report - some payers require the report be available within 24-48 hours of claim submission

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 72148 in 2025?

The 2025 Medicare national average payment rate for CPT 72148 is $188.26 for both facility and non-facility settings. This rate is based on 5.82 total RVUs multiplied by the 2025 conversion factor of $32.3465. Actual reimbursement may vary based on geographic location and MAC-specific adjustments.

What is the difference between CPT 72148 and 72149?

CPT 72148 is an MRI of the lumbar spine without contrast, while 72149 is an MRI lumbar spine with contrast material (gadolinium injection). Code 72149 involves intravenous administration of contrast agent to enhance visualization of certain pathologies like tumors, infections, or post-surgical changes. These codes are mutually exclusive and cannot be billed together for the same session.

Does CPT 72148 require prior authorization?

Prior authorization requirements vary by payer. Medicare typically does not require prior authorization for 72148, though some Medicare Advantage plans do. Most commercial insurance plans require pre-authorization for all MRI studies including 72148. Always verify authorization requirements with the specific payer before scheduling to avoid denials.

How many RVUs is CPT code 72148 worth?

CPT 72148 has a total of 5.82 RVUs in 2025, consisting of 1.48 work RVUs, 4.25 practice expense RVUs (both facility and non-facility), and 0.09 malpractice RVUs. This RVU value is established by CMS in the Medicare Physician Fee Schedule.

Can CPT 72148 and 72146 be billed together?

No, CPT 72148 (MRI lumbar without contrast) and 72146 (MRI lumbar with contrast) cannot be billed together for the same encounter. These are mutually exclusive codes. If both non-contrast and contrast sequences are performed in the same session, the appropriate code is 72158 (MRI lumbar without contrast followed by with contrast).

What diagnosis codes are typically used with CPT 72148?

Common ICD-10 codes paired with 72148 include M54.5 (low back pain), M51.26 (lumbar disc displacement with radiculopathy), M48.06 (lumbar spinal stenosis), M47.26 (lumbar spondylosis with radiculopathy), S39.012A (lumbar sprain/strain), and M51.36 (lumbar disc degeneration). Specific, detailed diagnosis codes improve approval rates and reduce medical necessity denials.

What modifiers are most commonly used with CPT 72148?

The most common modifiers for 72148 are modifier 26 (professional component only - for physician interpretation) and modifier TC (technical component only - for facility/equipment). Modifier 59 may be used to indicate a distinct procedural service when billed with other potentially bundled services. Modifier 76 is used for repeat procedures by the same physician on the same day.