CPT 72196Radiology

Mri pelvis w/dye

CPT code 72196 covers an MRI scan of the pelvis performed with contrast dye (a special substance injected to make internal structures show up more clearly on the images).

Showing rates for

National Average

Base Medicare rate

$264.27

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

1.73

PE RVU (NF)

6.33

MP RVU

0.11

Total RVU

8.17

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

NCCI bundling edits

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Billing tips

Verify contrast administration was actually performed and documented before billing 72196 instead of 72195 (without contrast)
Impact: Prevents $40-60 overpayment that will be recouped in audits and potential fraud investigation
Ensure the radiology report explicitly states 'with intravenous contrast' and documents contrast type, dose, and route of administration
Impact: Reduces denial rate by 35-40% for lack of contrast documentation
Check for valid medical necessity diagnoses such as neoplasm evaluation, pelvic mass, endometriosis, or inflammatory disease rather than screening codes
Impact: Prevents automatic denials; screening indications typically not covered, resulting in $264.27 writeoff
Bill the global code without modifiers when facility owns both technical and professional components; split with 26/TC only when appropriate
Impact: Maximizes reimbursement at full $264.27 rather than fragmented payments that may total less
Verify patient renal function (GFR/creatinine) was checked before contrast administration and documented in medical record
Impact: Prevents medical necessity denials and protects against liability; required by ACR guidelines
Do not bill 72196 and 72197 (MRI pelvis with and without contrast) together; 72197 is the comprehensive code that includes both
Impact: Prevents $264.27 denial for unbundling; bill only 72197 when both sequences performed

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 72196 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 72196 is $264.27 for both facility and non-facility settings. This is based on 8.17 total RVUs multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 72195 and 72196?

CPT 72195 is MRI of the pelvis without contrast material, while 72196 is MRI of the pelvis with contrast material (intravenous injection of gadolinium or other contrast agent). Code 72196 reimburses approximately $40-60 more than 72195 but requires documentation of actual contrast administration.

Can you bill CPT 72196 and 72197 together?

No, you cannot bill 72196 and 72197 together. CPT 72197 is the comprehensive code for MRI pelvis both without and with contrast material. If both non-contrast and contrast sequences are performed, bill only 72197. Billing both will result in denial for unbundling.

What RVU value does CPT 72196 have?

CPT 72196 has a total RVU of 8.17 for 2025, consisting of 1.73 work RVU, 6.33 practice expense RVU, and 0.11 malpractice RVU. The practice expense RVU is the same for both facility and non-facility settings at 6.33.

What diagnosis codes support medical necessity for CPT 72196?

Common supporting diagnosis codes include malignant neoplasms of pelvic organs (C53-C57, C61, C67), endometriosis (N80), pelvic inflammatory disease (N70-N77), pelvic mass (R19.05), rectal bleeding (K62.5), and post-surgical follow-up (Z09). Screening codes typically do not support medical necessity.

Do I need modifier 26 or TC when billing CPT 72196?

Use modifier 26 when billing only the professional component (radiologist interpretation). Use modifier TC when billing only the technical component (equipment, contrast, technologist). If your facility owns both components, bill the global code without modifiers to receive the full $264.27 reimbursement.

How do I document contrast administration for CPT 72196?

Documentation must include: contrast agent name (e.g., Gadavist, Dotarem), concentration, volume/dose administered, route (intravenous), time of injection, and confirmation that contrast-enhanced sequences were obtained. The radiology report must explicitly state 'with intravenous contrast' and the technologist should document IV placement and contrast injection.