CPT 72170Radiology

X-ray exam of pelvis

CPT code 72170 covers a standard X-ray examination of the pelvis, typically performed to evaluate bone fractures, joint problems, or abnormalities in the pelvic region. This is one of the most common diagnostic imaging procedures ordered in emergency rooms and orthopedic practices.

Showing rates for

National Average

Base Medicare rate

$27.17

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

0.17

PE RVU (NF)

0.65

MP RVU

0.02

Total RVU

0.84

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

NCCI bundling edits

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Billing tips

Verify the number of views documented matches code selection - 72170 is for limited views (1-2); use 72190 for complete pelvis series (3+ views)
Impact: Incorrect view count is the leading cause of denials; upgrading to 72190 when appropriate increases reimbursement from $27.17 to approximately $39-45
Always verify place of service (POS) code matches actual location - both facility and non-facility rates are identical at $27.17, but incorrect POS triggers audits
Impact: POS code errors account for 15-20% of claim rejections and can delay payment by 30-45 days
Bundle appropriately with E/M services - if pelvis X-ray is the sole reason for visit, bill separately; if part of comprehensive visit, ensure modifier 25 on E/M is justified
Impact: Improper bundling or unbundling can result in $50-150 payment reduction per encounter or trigger compliance review
Document medical necessity clearly with ICD-10 codes that support imaging - generic pain codes without trauma or clinical indication increase denial risk
Impact: Medical necessity denials require costly appeals; appropriate diagnosis coding reduces denial rate from 12-15% to 2-3%
For repeat imaging same day, use modifier 76 and document clinical change or inadequate initial study - do not bill as new study without modifier
Impact: Missing modifier 76 results in automatic denial of second claim; proper use recovers full $27.17 for medically necessary repeat study
Separate professional and technical components only when services are split between facilities - billing both when providing global service triggers overpayment recovery

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 72170 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 72170 is $27.17 for both facility and non-facility settings. This rate is based on 0.84 total RVUs (0.17 work RVU, 0.65 practice expense RVU, 0.02 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 72170 and 72190?

CPT 72170 is for a limited pelvis X-ray examination with 1-2 views, while CPT 72190 is for a complete pelvis X-ray series with minimum 3 views. The number of views documented in the radiology report determines which code to use; 72190 has higher reimbursement due to more comprehensive imaging.

Can CPT 72170 be billed with an E/M code on the same date of service?

Yes, CPT 72170 can be billed with an E/M code on the same date when the E/M service is significant and separately identifiable from the decision to order the X-ray. Append modifier 25 to the E/M code and ensure documentation supports the separate service. The X-ray itself does not require a modifier in this scenario.

What diagnosis codes support medical necessity for CPT 72170?

Common supporting diagnosis codes include S32.x (pelvic fractures), M25.55x (hip pain), M16.x (hip osteoarthritis), S39.01xA (pelvic strain), W19.xxxx (fall codes), and M84.4x (pathological fracture). Avoid using only non-specific codes like R10.9 (unspecified abdominal pain) without additional clinical context, as these may be denied for lack of medical necessity.

Do I need to use modifier 26 or TC when billing CPT 72170?

Use modifier 26 (professional component) only when billing for the physician interpretation separately, typically when a radiologist reads films taken at a different facility. Use modifier TC (technical component) when billing only for the equipment and technologist services. If your facility provides both the imaging and interpretation, bill the global code 72170 without modifiers.

How many RVUs is CPT code 72170 worth?

CPT 72170 has a total RVU value of 0.84 for 2025, consisting of 0.17 work RVUs, 0.65 practice expense RVUs (both facility and non-facility), and 0.02 malpractice RVUs. This is considered a low-RVU procedure reflecting its relatively simple and quick nature.

What are common billing errors to avoid with CPT 72170?

Common errors include: billing 72170 when 3+ views were obtained (should be 72190), failing to document medical necessity, billing without a physician order, using inappropriate diagnosis codes, double-billing when CT or MRI of pelvis is performed same day, and splitting components (26/TC) when providing global service. Always verify view count matches code selection.