CPT 72193Radiology

Ct pelvis w/dye

CPT 72193 covers a CT scan of the pelvis performed with contrast dye injected into a vein to enhance image quality and help doctors identify tumors, infections, or other abnormalities.

Showing rates for

National Average

Base Medicare rate

$223.19

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

1.16

PE RVU (NF)

5.67

MP RVU

0.07

Total RVU

6.9

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

NCCI bundling edits

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Billing tips

Verify contrast administration is documented in radiology report and nursing/technologist notes; include specific contrast agent name, dose, route, and timing
Impact: Missing contrast documentation triggers downcoding to 72192 (without contrast), reducing payment by approximately $40-60
Ensure referring diagnosis supports medical necessity - pelvic pain alone may not suffice; document specific clinical indication such as 'rule out appendicitis,' 'pelvic mass on exam,' or 'cancer staging'
Impact: Improves first-pass approval rate by 25-35% and reduces medical necessity denials
Do not bill 72193 with 72194 (CT pelvis without then with contrast) on same date - 72194 is the comprehensive code that includes both phases
Impact: Prevents denial for unbundling; 72194 pays approximately $80-100 more than 72193 alone
When billing professional component (modifier 26), ensure interpretation report includes all required elements: clinical indication, technique, findings, and impression signed by interpreting radiologist
Impact: Incomplete reports are primary cause of professional component denials, affecting approximately 30% of reimbursement
Check for LCD/LCDs (Local Coverage Determinations) for your MAC regarding covered diagnoses; maintain internal list of approved ICD-10 codes that support 72193
Impact: Pre-verification reduces denial rate by 15-20% and accelerates payment timeline
For hospital outpatient departments, ensure technical component is billed on UB-04 with appropriate revenue code (0350 for CT scan) while professional component goes on CMS-1500

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 72193 in 2025?

The 2025 Medicare national average payment for CPT 72193 is $223.19 for both facility and non-facility settings. This is based on a total RVU of 6.9 and the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustment factors.

What is the difference between CPT 72192, 72193, and 72194?

CPT 72192 is CT pelvis without contrast, 72193 is CT pelvis with contrast only, and 72194 is CT pelvis without contrast followed by with contrast (both phases). Code 72194 should be used when both non-contrast and contrast phases are medically necessary and performed. Never bill 72192 and 72193 together - use 72194 instead.

How many RVUs is CPT code 72193 worth?

CPT 72193 has a total of 6.9 RVUs for 2025, consisting of 1.16 work RVUs, 5.67 practice expense RVUs (both facility and non-facility), and 0.07 malpractice RVUs. This RVU value is from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Does CPT 72193 require prior authorization?

Prior authorization requirements vary by payer and state. Medicare Advantage plans frequently require prior auth for advanced imaging including CT scans. Traditional Medicare does not require prior authorization but does expect medical necessity. Commercial payers increasingly require authorization through radiology benefit managers (RBMs). Always verify requirements before scheduling.

Can you bill 72193 and 74177 together?

Generally no - CPT 74177 is CT abdomen and pelvis with contrast, which includes the pelvic imaging covered by 72193. Billing both would be considered duplicate/unbundled services. Use 74177 when both abdomen and pelvis are scanned, or 72193 when only the pelvis is imaged. Check NCCI edits for specific bundling rules.

What diagnosis codes are typically used with CPT 72193?

Common ICD-10 codes include R10.2 (pelvic pain), C67.9 (bladder malignancy), N13.30 (hydronephrosis), R31.9 (hematuria), D49.9 (neoplasm uncertain behavior), K63.5 (polyp of colon), N80.9 (endometriosis), and trauma codes. The diagnosis must justify the need for contrast enhancement - vague symptoms alone may not support medical necessity.

What are the documentation requirements for contrast administration for CPT 72193?

Required documentation includes: type and dose of contrast agent, route and time of administration, assessment of renal function (creatinine/GFR) prior to contrast, patient consent, screening for contraindications (allergies, kidney disease), and monitoring for adverse reactions. The radiology report must explicitly state that IV contrast was administered and describe the enhancement pattern.