CPT 72255Radiology

Myelography thoracic spine

CPT 72255 covers myelography of the thoracic spine, an imaging procedure where contrast dye is injected into the spinal canal to visualize the spinal cord and nerve roots in the mid-back region. This helps diagnose conditions like herniated discs, spinal stenosis, or tumors affecting the thoracic spine.

Showing rates for

National Average

Base Medicare rate

$102.86

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)

2.22

MP RVU

0.05

Total RVU

3.18

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

NCCI bundling edits

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Billing tips

Bill the contrast injection separately using CPT 62284 (injection procedure for myelography via lumbar approach) or 62302-62305 for spinal puncture, as 72255 covers only supervision and interpretation
Impact: Additional $150-300 reimbursement for injection procedure; failure to bill separately results in 60-70% revenue loss
Verify whether setting is facility or non-facility; both have identical rates ($102.86) for 72255, but modifier usage (26/TC) differs based on ownership of equipment
Impact: Incorrect modifier use can result in 100% denial or overpayment recoupment
Document post-myelography CT if performed (CPT 72252 or 72253) as this is separately billable and commonly performed after thoracic myelography
Impact: Additional $200-400 reimbursement when medically indicated; ensure distinct documentation
Include number of images, type of contrast used, and detailed findings in the interpretation report to support medical necessity
Impact: Reduces audit risk by 40-50%; supports appeals for any medical necessity denials
For same-day E/M services, append modifier 25 to the E/M code (not to 72255) and document separately identifiable evaluation beyond the procedure decision
Impact: Protects $100-300 E/M reimbursement that would otherwise be bundled and denied
Confirm prior authorization requirements for myelography, as many payers require pre-certification despite the relatively low reimbursement
Impact: Prevents 100% denial ($102.86 loss) plus potential patient balance billing issues

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 72255 in 2025?

The 2025 Medicare national average payment for CPT 72255 is $102.86 for both facility and non-facility settings. This rate is based on a total RVU of 3.18 (Work RVU 0.91, PE RVU 2.22, MP RVU 0.05) multiplied by the 2025 conversion factor of 32.3465.

Does CPT 72255 include the contrast injection procedure?

No, CPT 72255 covers only the radiological supervision and interpretation of thoracic myelography. The contrast injection must be billed separately using CPT 62284 (injection for myelography via lumbar) or appropriate spinal puncture codes (62302-62305) depending on the approach and technique used.

Can I bill 72255 and CT myelography codes together?

Yes, CPT 72255 (conventional myelography) can be billed with CT myelography codes 72252 or 72253 when both are performed and documented. The conventional images and CT images represent distinct components of a comprehensive myelographic study, though some payers may require modifier 59 to indicate distinct services.

What modifiers are most commonly used with CPT 72255?

Modifier 26 (professional component) and TC (technical component) are most common for split billing between interpreting physician and facility. Modifier 59 may be needed to unbundle from same-day procedures, and modifier 76 for repeat studies on the same day by the same physician.

What diagnosis codes support medical necessity for thoracic myelography?

Common supporting ICD-10 codes include M50.x (thoracic disc disorders), M48.06 (spinal stenosis, thoracic region), C79.49 (secondary malignant neoplasm of spine), G95.x (spinal cord diseases), and M54.6 (pain in thoracic spine). Documentation should explain why MRI is inadequate or contraindicated.

Is prior authorization required for CPT 72255?

Prior authorization requirements vary by payer, but most Medicare Advantage plans and commercial insurers do require pre-certification for myelography due to the invasive nature and availability of less-invasive alternatives like MRI. Always verify authorization requirements before scheduling to avoid denials.

What is the difference between CPT 72255 and 72265?

CPT 72255 is myelography of the thoracic spine (mid-back), while 72265 is myelography of the lumbosacral spine (lower back). The anatomical region imaged determines the correct code. Both have the same 2025 Medicare rate of $102.86 and identical RVU values.