CPT 72190Radiology

X-ray exam of pelvis

CPT code 72190 is used when a healthcare provider takes standard X-ray images of your pelvis to evaluate bones, joints, or detect abnormalities. This is a basic diagnostic imaging test that helps doctors see the hip bones, sacrum, and pelvic structures.

Showing rates for

National Average

Base Medicare rate

$40.76

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

0.25

PE RVU (NF)

0.99

MP RVU

0.02

Total RVU

1.26

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

NCCI bundling edits

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Billing tips

Verify place of service code matches facility vs. non-facility setting, though 72190 has identical rates ($40.76) for both
Impact: While rates are equal for this code, incorrect POS can trigger audit flags and delay payment by 30-45 days
Bundle with appropriate E/M code when ordering physician also performs evaluation; do not separately bill for merely ordering the X-ray
Impact: Prevents unbundling denials; the decision to order is included in E/M service and not separately reimbursable
Document the specific clinical indication and number of views obtained in the requisition and radiology report
Impact: Reduces medical necessity denials by 60-70%; lack of indication is the top denial reason for diagnostic imaging
Do not bill 72190 with 72170 (pelvis, minimum 1 view) or 72191-72194 on same date unless distinct clinical indications exist
Impact: Prevents $40.76 denial for bundling violations; payers will reimburse only the most comprehensive code
For Medicare patients, ensure ordering physician has valid NPI and is enrolled in PECOS; include on claim per PAMA requirements
Impact: Missing or invalid ordering physician information results in automatic denial; can delay payment 60+ days
Bill global service unless your facility splits professional and technical components; incorrect modifier use loses reimbursement
Impact: Using modifier 26 or TC incorrectly can result in 50-75% underpayment that may go unnoticed

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 72190 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 72190 is $40.76 for both facility and non-facility settings. This rate is based on 1.26 total RVUs multiplied by the 2025 conversion factor of 32.3465.

How many views are included in CPT code 72190?

CPT 72190 represents a complete radiographic examination of the pelvis, typically including a minimum of 1-2 views. The exact number of views is not specified in the code descriptor and may vary based on clinical indication, but standard protocols usually include AP and additional views as needed.

What is the difference between CPT 72170 and 72190?

CPT 72170 is for a limited pelvis X-ray with minimum 1 view, while CPT 72190 represents a more complete examination. Code 72190 is used for standard diagnostic pelvic radiography with multiple views, whereas 72170 is reserved for limited follow-up or specific screening purposes.

Can I bill CPT 72190 and 73521 on the same day?

Yes, CPT 72190 (pelvis X-ray) and 73521 (bilateral hip X-ray) can be billed together if they represent distinct examinations with separate clinical indications. However, ensure documentation clearly supports the medical necessity for both studies, as there is anatomical overlap that may trigger payer review.

Does CPT 72190 require prior authorization for Medicare?

Traditional Medicare does not typically require prior authorization for CPT 72190, but some Medicare Advantage plans may. Additionally, radiology benefit management (RBM) companies may require appropriate use criteria documentation. Always verify requirements with the specific payer.

What diagnosis codes support medical necessity for CPT 72190?

Common supporting ICD-10 codes include M25.559 (hip pain), S32.9XXA (pelvic fracture), M16.0-M16.9 (osteoarthritis of hip), R10.2 (pelvic pain), and Z96.64- (orthopedic joint implant presence). The diagnosis must support the clinical need for pelvic imaging.

How do I bill CPT 72190 with modifier 26 vs TC?

Use modifier 26 when billing only for the physician's interpretation and written report (professional component). Use modifier TC when billing only for the equipment, technologist, and supplies (technical component). Bill without modifiers for global service including both components at the full $40.76 rate.