CPT 72240Radiology

Myelography neck spine

CPT 72240 covers myelography of the cervical spine, an imaging study where contrast dye is injected into the spinal canal to visualize the spinal cord and nerve roots in the neck area.

Showing rates for

National Average

Base Medicare rate

$107.71

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

0.91

PE RVU (NF)

2.36

MP RVU

0.06

Total RVU

3.33

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

NCCI bundling edits

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Billing tips

Always verify whether you're billing globally or splitting 26/TC components based on your facility arrangement
Impact: Incorrect component billing can result in 100% denial or significant overpayment recovery; the 2025 rate of $107.71 assumes global billing
Document the specific contrast material used, volume injected, and fluoroscopic guidance in the interpretation report
Impact: Missing contrast documentation is the #1 reason for downcoding to non-contrast study, reducing reimbursement by approximately 40-60%
Bill the injection procedure separately using CPT 62284 (cervical/thoracic injection) when performed by the same provider
Impact: Adds approximately $91.50 to total reimbursement when properly documented and coded separately from supervision/interpretation
Submit claims with diagnosis codes that support medical necessity such as cervical radiculopathy (M54.12) or spinal stenosis (M48.02)
Impact: Non-specific diagnosis codes like neck pain alone increase denial risk by 30-40%; specific anatomic diagnoses improve first-pass acceptance
When billing with CT myelography (72126-72127), ensure proper sequencing and modifier use to avoid NCCI edits
Impact: Improper bundling can result in denial of the $107.71 myelography component; modifier 59 or XS may be required depending on payer
Verify pre-authorization requirements with commercial payers before scheduling as many require prior approval for myelography
Impact: Lack of pre-authorization results in 100% denial for most commercial payers regardless of medical necessity; appeals rarely succeed

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 72240 in 2025?

The 2025 Medicare national average payment for CPT 72240 is $107.71 for both facility and non-facility settings. This rate is based on a total RVU of 3.33 multiplied by the 2025 conversion factor of 32.3465.

Can CPT 72240 be billed with CT myelography codes on the same date?

Yes, CPT 72240 can be billed with CT myelography codes (72126-72127) when both are performed, but modifier 59 or XS may be required to bypass NCCI bundling edits. Documentation must support the medical necessity of both the initial myelogram and subsequent CT imaging.

What RVUs are assigned to CPT 72240 for 2025?

CPT 72240 has a Work RVU of 0.91, Practice Expense RVU of 2.36 (both facility and non-facility), Malpractice RVU of 0.06, for a total of 3.33 RVUs in 2025.

Do I need modifier 26 when billing CPT 72240 for radiologist interpretation only?

Yes, append modifier 26 when billing only the professional component (radiologist interpretation) of cervical myelography. The facility separately bills the technical component with modifier TC. Without proper modifier use, global billing assumes both components are included.

What diagnosis codes support medical necessity for CPT 72240?

Common supporting diagnoses include cervical radiculopathy (M54.12-M54.13), cervical spinal stenosis (M48.02), cervical intervertebral disc disorders (M50.x series), myelopathy (M50.0x), and suspected cervical cord compression. Non-specific neck pain alone typically does not meet medical necessity criteria.

Is prior authorization required for CPT 72240 myelography?

Prior authorization requirements vary by payer. Medicare typically does not require pre-authorization, but most commercial insurance plans and Medicare Advantage plans do require prior approval for cervical myelography. Always verify with the specific payer before scheduling.

How is CPT 72240 different from the myelography injection code?

CPT 72240 represents only the radiological supervision and interpretation of cervical myelography. The actual injection procedure into the spinal canal is reported separately using CPT 62284 (cervical/thoracic injection). Both codes can be billed when the same provider performs both services with proper documentation.