CPT 72220Radiology

X-ray exam sacrum tailbone

CPT code 72220 covers an X-ray examination of the sacrum and tailbone (coccyx), the bones at the base of the spine. This diagnostic imaging helps doctors identify fractures, arthritis, tumors, or other abnormalities causing lower back or tailbone pain.

Showing rates for

National Average

Base Medicare rate

$31.70

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

0.17

PE RVU (NF)

0.79

MP RVU

0.02

Total RVU

0.98

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

NCCI bundling edits

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Billing tips

Always verify whether your facility setting is facility or non-facility for accurate reimbursement expectations, though for 72220 both rates are identical at $31.70
Impact: Prevents reconciliation issues and ensures correct contract negotiations despite identical Medicare rates
Document the specific number of views obtained (minimum 2 for 72220) and medical necessity linking to a diagnosis code for trauma, pain, or suspected pathology
Impact: Reduces denial risk by 70-80% according to radiology billing audits; lack of medical necessity is the #1 denial reason
Bill global code 72220 only when your facility owns equipment and provides interpretation; split with 26/TC modifiers when services are divided
Impact: Incorrect component billing can result in overpayment recovery demands or underpayment of 40-60% of expected reimbursement
Link to appropriate ICD-10 codes documenting specific site and nature of complaint (S32.2XXA for coccyx fracture, M53.3 for sacrococcygeal disorders, M54.5 for low back pain)
Impact: Specific diagnosis coding prevents medical necessity denials and supports LCD/NCD compliance
Verify payer-specific requirements for prior authorization as some commercial payers require pre-cert even for basic X-rays under radiology benefit management programs
Impact: Prevents denials that require costly appeals; retroactive authorization often denied resulting in 100% write-off
Do not bill 72220 with complete spine series codes (72010, 72020) on same date as it represents component of those comprehensive studies
Unbundling violations can trigger NCCI edits resulting in automatic denial plus potential fraud investigation

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 72220 in 2025?

The 2025 Medicare national average payment for CPT 72220 is $31.70 for both facility and non-facility settings. This is based on 0.98 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality based on GPCI adjustments.

How many views are required for CPT code 72220?

CPT 72220 typically requires a minimum of two views of the sacrum and coccyx, usually anteroposterior (AP) and lateral projections. If fewer views are obtained due to patient limitations, modifier 52 (reduced services) should be appended and documentation should explain why complete imaging was not possible.

Can I bill CPT 72220 with a lumbar spine X-ray on the same day?

Yes, CPT 72220 can be billed separately from lumbar spine X-rays (72100, 72110, 72114, 72120) when both are medically necessary and clinically indicated, as they represent different anatomic areas. However, do not bill 72220 separately when a complete spine series (72010, 72020) is performed, as those comprehensive codes include sacral imaging.

What diagnosis codes support medical necessity for 72220?

Common supporting diagnosis codes include S32.2XXA (coccyx fracture), M53.3 (sacrococcygeal disorders), M54.5 (low back pain), M43.8X8 (other specified deforming dorsopathies of sacral region), and R10.2 (pelvic/perineal pain). The diagnosis must clearly document clinical indication for sacral/coccyx imaging specifically.

Do I need to use modifier 26 or TC when billing 72220?

Use modifier 26 (professional component) when billing only for the physician interpretation and report. Use modifier TC (technical component) when billing only for the equipment, technologist, and supplies. Bill the global code 72220 without modifiers only when your practice provides both the technical and professional services.

What are the RVU values for CPT 72220 in 2025?

For 2025, CPT 72220 has a Work RVU of 0.17, Practice Expense RVU of 0.79 (both facility and non-facility), Malpractice RVU of 0.02, totaling 0.98 RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

How do I appeal a medical necessity denial for CPT 72220?

Submit the provider's clinical notes documenting specific patient symptoms (tailbone pain, trauma history, etc.), physical exam findings, and how the imaging influenced treatment decisions. Include references to published clinical guidelines supporting X-ray imaging for the documented condition and cite any applicable LCD/NCD criteria. Demonstrate that less expensive or non-radiologic evaluation was insufficient.