CPT 72158Radiology

Mri lumbar spine w/o & w/dye

CPT code 72158 represents an MRI (magnetic resonance imaging) scan of the lower back (lumbar spine) performed twice—once without contrast dye and once with contrast dye injected into a vein. This dual-phase imaging helps doctors see spinal structures, nerves, and abnormalities more clearly than a single scan.

Showing rates for

National Average

Base Medicare rate

$314.41

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

2.29

PE RVU (NF)

7.27

MP RVU

0.16

Total RVU

9.72

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

NCCI bundling edits

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Billing tips

Verify prior authorization before scheduling, as most commercial payers require pre-approval for MRI with contrast studies
Impact: Prevents denials averaging $314.41 per claim; authorization denials account for 35-40% of initial rejections for advanced imaging
Document medical necessity for both non-contrast and contrast phases explicitly in the ordering physician's clinical notes, not just 'MRI lumbar with and without contrast'
Impact: Reduces medical necessity denials by 60-70%; payers frequently downcode to 72148 (without contrast only) when justification unclear
Confirm patient renal function (GFR/creatinine) is documented within acceptable limits before contrast administration, particularly for patients over 60 or with diabetes
Impact: Prevents need for modifier 52 reduction and potential medical liability; also satisfies ACR safety guidelines required by many payers
Bill facility and professional components correctly based on setting—use no modifier for global billing, or split with 26/TC modifiers appropriately
Impact: Incorrect component billing results in 50-100% payment reductions; facility rate equals non-facility rate at $314.41, but component splits differ
When ordered for post-surgical evaluation, ensure documentation specifies timeframe since surgery and clinical indication beyond routine follow-up
Impact: Post-op imaging within 90 days often denied without specific complication or new symptom documentation; appeals successful in only 40% of cases
Do not bill 72158 with 72148 (without contrast) or 72149 (with contrast only) on the same date—72158 includes both sequences

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 72158 in 2025?

The 2025 Medicare national average payment rate for CPT 72158 is $314.41 for both facility and non-facility settings. This is based on 9.72 total RVUs (2.29 work RVU, 7.27 PE RVU, 0.16 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 72158 and 72148?

CPT 72158 includes MRI imaging of the lumbar spine performed both without and with intravenous contrast material (two separate sequences), while CPT 72148 is MRI of the lumbar spine without contrast only. Code 72158 should only be used when both phases are medically necessary and performed; it cannot be billed together with 72148 on the same date as it would be considered unbundling.

Does CPT 72158 require prior authorization?

Most commercial insurance plans and Medicare Advantage plans require prior authorization for CPT 72158 due to its classification as advanced imaging with contrast. Traditional Medicare does not require prior authorization but may conduct post-payment review. Always verify specific payer requirements before scheduling, as lack of authorization is a leading cause of denial for this code.

How many RVUs is CPT code 72158 worth?

CPT 72158 has a total of 9.72 RVUs in 2025, consisting of 2.29 work RVUs, 7.27 practice expense RVUs (both facility and non-facility), and 0.16 malpractice RVUs. This makes it a relatively high-value diagnostic imaging code, reflecting the technical complexity and professional interpretation required.

Can you bill CPT 72158 with modifier 26 or TC?

Yes, CPT 72158 can be split into professional and technical components using modifier 26 (professional component for physician interpretation only) or modifier TC (technical component for equipment and staff only). This split billing is appropriate when the interpreting radiologist is separate from the facility performing the scan, such as when a radiologist reads images from an independent imaging center.

What diagnosis codes support medical necessity for CPT 72158?

Diagnosis codes supporting 72158 typically include suspected or confirmed spinal neoplasms (C41.2, C79.51), post-laminectomy syndrome (M96.1), discitis/osteomyelitis (M46.2x), spinal stenosis with complications (M48.06), complex radiculopathy (M54.16), metastatic disease to spine, or post-surgical complications. Simple mechanical back pain (M54.5) or uncomplicated disc disease generally do not justify contrast administration and may result in downcoding to 72148.

How often can CPT 72158 be billed for the same patient?

There is no specific Medicare frequency limitation for 72158, but medical necessity must be documented for each study. Most payers question repeat lumbar spine MRIs within 6-12 months unless there is documented interval change in symptoms, new neurological deficit, post-surgical complications, or failed treatment. Billing more frequently requires strong clinical justification including specific interval changes and why repeat contrast imaging is necessary rather than non-contrast follow-up.