CPT 72195Radiology

Mri pelvis w/o dye

CPT code 72195 covers an MRI (magnetic resonance imaging) scan of the pelvis performed without contrast dye. This diagnostic imaging test uses magnetic fields and radio waves to create detailed pictures of pelvic bones, organs, blood vessels, and soft tissues.

Showing rates for

National Average

Base Medicare rate

$224.48

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

1.46

PE RVU (NF)

5.39

MP RVU

0.09

Total RVU

6.94

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

NCCI bundling edits

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Billing tips

Verify contrast administration status before coding - code 72195 is for WITHOUT contrast only; use 72196 for WITH contrast or 72197 for WITHOUT followed by WITH contrast
Impact: Prevents 100% claim denial and ensures correct $224.48 reimbursement versus $292.89 for contrast studies
Document medical necessity clearly linking the clinical indication to specific pelvic pathology; generic 'pelvic pain' often triggers denials without additional specificity
Impact: Reduces denial rate by 30-40% and eliminates need for time-consuming appeals
Bill global code without modifiers when your facility owns equipment and provides interpretation; split with 26/TC modifiers only when components are separated between facilities
Impact: Maximizes reimbursement to full $224.48 when applicable and avoids modifier misuse audit flags
Confirm anatomical specificity - pelvis (72195) versus lumbar spine (72148), hip joint (73721), or abdomen (74181-74183); overlapping anatomy requires careful documentation
Impact: Prevents downcoding or denial; ensures payment at correct rate versus potential $50-100 difference in reimbursement
Obtain prior authorization before scheduling as most commercial payers require pre-approval for MRI studies; Medicare Advantage plans often have different requirements than traditional Medicare
Impact: Eliminates 80-90% of authorization-related denials and reduces accounts receivable delays by 15-30 days
When performed same day as other imaging, document separate medical necessity and use modifier 59 only when truly distinct; audit risk increases with routine modifier 59 use

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 72195 in 2025?

The 2025 Medicare national average payment for CPT 72195 is $224.48 for both facility and non-facility settings. This rate is based on 6.94 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality.

What is the difference between CPT codes 72195, 72196, and 72197?

CPT 72195 is MRI pelvis without contrast dye, 72196 is MRI pelvis with contrast material, and 72197 is MRI pelvis without contrast followed by with contrast and further sequences. The codes cannot be billed together for the same session - only one should be selected based on the actual protocol performed.

Does CPT 72195 require prior authorization from Medicare?

Traditional Medicare does not typically require prior authorization for 72195, but Medicare Advantage plans often do require pre-approval. Additionally, the Protecting Access to Medicare Act (PAMA) requires use of appropriate use criteria through qualified clinical decision support mechanisms for advanced imaging, which may function similarly to authorization.

Can CPT 72195 be billed with modifier 26 or TC?

Yes, CPT 72195 can be split using modifier 26 for the professional component (radiologist interpretation) or TC for the technical component (equipment and technologist). Use these modifiers only when the professional and technical components are performed by different entities. When the same entity provides both, bill the global code without modifiers.

What diagnosis codes support medical necessity for CPT 72195?

Common supporting diagnoses include pelvic pain (R10.2), endometriosis (N80.x), uterine fibroids (D25.x), ovarian cysts (N83.2x), hip pain (M25.55x), sacroiliac joint disorders (M53.3), pelvic fractures (S32.x), avascular necrosis (M87.x), and pelvic masses (R19.0x). Local Coverage Determinations should be reviewed for specific payer requirements.

How many RVUs is CPT code 72195 worth in 2025?

CPT 72195 has a total of 6.94 RVUs in 2025, consisting of 1.46 work RVUs, 5.39 practice expense RVUs (both facility and non-facility), and 0.09 malpractice RVUs. This RVU value is consistent across facility and non-facility settings for this particular code.

Can CPT 72195 and 72148 (MRI lumbar spine) be billed together on the same date of service?

Yes, CPT 72195 (MRI pelvis) and 72148 (MRI lumbar spine) can be billed together when both are medically necessary and distinct anatomical areas are being evaluated for different clinical indications. However, documentation must clearly support separate medical necessity for each region, and modifier 59 may be required on one code to indicate they are distinct procedural services addressing different clinical questions.