CPT 72198Radiology

Mr angio pelvis w/o & w/dye

CPT code 72198 covers magnetic resonance angiography (MRA) of the pelvis performed both without and with contrast dye. This advanced imaging technique creates detailed pictures of blood vessels in the pelvic region to detect blockages, aneurysms, or other vascular abnormalities.

Showing rates for

National Average

Base Medicare rate

$333.17

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

1.8

PE RVU (NF)

8.36

MP RVU

0.14

Total RVU

10.3

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

NCCI bundling edits

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Billing tips

Verify complete documentation of both non-contrast and post-contrast sequences in the technical report and radiologist interpretation
Impact: Missing documentation of dual-phase protocol triggers downcoding to 72197 (without contrast), reducing reimbursement from $333.17 to $257.49, a $75.68 loss
Document medical necessity for contrast administration specifically, including contraindications to alternative imaging and clinical question requiring vascular detail
Impact: Prevents medical necessity denials that result in 100% claim rejection; particularly critical for Medicare Advantage and commercial payors requiring prior authorization
Bill in non-facility setting when applicable to maximize reimbursement; verify place of service code 11 (office) or 22 (outpatient hospital) is correct
Impact: Both settings reimburse at $333.17 for this code, but verify site-of-service requirements and ensure proper facility agreements are in place
Do not bill 72198 with 72195 (same area without and with contrast) on same date of service unless distinct imaging sessions with separate medical necessity
Impact: Prevents bundling denial and potential fraud investigation; use modifier 59 only when truly distinct sessions with clear documentation
Check for LCD/NCD requirements in your MAC jurisdiction regarding covered indications for pelvic MRA before scheduling
Impact: Prevents denial for non-covered indications; some MACs require specific diagnoses or failed prior imaging to support medical necessity
Document gadolinium contrast agent type, dose, administration route, and patient tolerance in medical record

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 72198 in 2025?

The 2025 Medicare national average reimbursement for CPT 72198 is $333.17 for both facility and non-facility settings. This rate is based on 10.3 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality adjustment.

What is the difference between CPT 72198 and 72197?

CPT 72198 is MR angiography of the pelvis performed both without and with contrast (dual-phase protocol), while 72197 is performed without contrast only. Code 72198 requires documentation of imaging both before and after gadolinium administration and reimburses at $333.17 compared to $257.49 for 72197.

Can I bill CPT 72198 and 74185 together on the same date of service?

Yes, if medically necessary and imaging different anatomic areas. CPT 74185 is MRA of abdomen, while 72198 is pelvis. Use modifier 59 on the secondary code if needed to indicate distinct procedural service. Documentation must support separate clinical indications for both areas and show distinct imaging protocols.

Does CPT 72198 require prior authorization from Medicare?

Traditional Medicare does not require prior authorization for 72198, but Medicare Advantage plans often do. Some MACs participate in the Advanced Imaging Prior Authorization program. Always verify requirements with the specific payor and check local coverage determinations (LCDs) for your MAC jurisdiction before scheduling.

What diagnosis codes support medical necessity for CPT 72198?

Common supporting diagnoses include peripheral arterial disease (I73.9), pelvic pain (R10.2), suspected vascular malformation (Q27.8), aneurysm evaluation (I72.x codes), pre-operative vascular mapping, and tumor vascularity assessment. Always verify current LCD requirements for your MAC as covered indications may vary by jurisdiction.

How many RVUs is CPT code 72198 worth in 2025?

CPT 72198 has 10.3 total RVUs in 2025, consisting of 1.8 work RVUs, 8.36 practice expense RVUs, and 0.14 malpractice RVUs. Both facility and non-facility settings have the same RVU values for this code.

Can I bill modifier 26 with CPT 72198 if I only read the images?

Yes, radiologists who only provide professional interpretation without owning the imaging equipment should bill 72198-26 for the professional component. The imaging facility bills 72198-TC for the technical component. Do not bill the global code 72198 without a modifier unless you provide both components.