CPT 72265Radiology

Myelography l-s spine

CPT code 72265 covers myelography of the lower back and sacral spine, an imaging procedure where contrast dye is injected into the spinal canal to visualize nerve roots, the spinal cord, and surrounding structures on X-ray images.

Showing rates for

National Average

Base Medicare rate

$104.80

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

0.83

PE RVU (NF)

2.36

MP RVU

0.05

Total RVU

3.24

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

NCCI bundling edits

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Billing tips

Always verify whether you are billing the complete procedure or just the professional/technical component based on your practice setting
Impact: Incorrect component billing can result in 100% denial or significant overpayment recovery; facility-based radiologists should append modifier 26
Bill contrast material separately using HCPCS codes (e.g., Q9967 for low osmolar contrast) as 72265 does not include contrast supply
Impact: Failure to bill contrast separately results in $50-150 loss per procedure depending on contrast type and volume used
Document and bill post-myelography CT (72129-72133) or MRI separately when performed, as these are distinct procedures from the myelogram
Impact: Post-myelography CT adds $200-400 in reimbursement; ensure separate documentation and consider timing to avoid bundling edits
Link appropriate ICD-10 diagnosis codes demonstrating medical necessity, particularly for Medicare patients where myelography requires specific clinical indications
Impact: Missing or non-specific diagnosis codes trigger automatic denials; proper coding prevents $104.80 payment loss and appeal costs
When performed same day as lumbar puncture (62270), ensure documentation clearly establishes myelography as the primary procedure to avoid downcoding
Impact: Improper sequencing may result in lumbar puncture being paid and myelography denied as inclusive, losing the higher-valued procedure
For hospital outpatient settings, ensure facility bills on UB-04 with revenue code 0350 or 0610 while physician bills professional component on CMS-1500
Claim form errors cause processing delays of 30-60 days and potential denial; proper form usage ensures timely $104.80 payment

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 72265 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 72265 is $104.80 for both facility and non-facility settings. This rate is based on 3.24 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustment.

Can CPT 72265 be billed with a post-myelography CT scan?

Yes, post-myelography CT imaging (CPT codes 72129-72133) can and should be billed separately from 72265 when performed, as these are distinct procedures. The myelogram (72265) involves the contrast injection and initial radiographic imaging, while the CT represents additional cross-sectional imaging performed after contrast distribution. Ensure separate documentation for each service.

What is the difference between CPT 72265 and 62284?

CPT 72265 is the radiological supervision and interpretation for lumbar myelography, while CPT 62284 represents the injection procedure for myelography (the actual lumbar puncture and contrast administration). In most cases, 62284 is bundled into 72265 when performed by the same physician. Only bill both codes when different physicians perform the injection versus the imaging interpretation.

Does CPT 72265 include the contrast material cost?

No, CPT 72265 does not include the contrast material itself. The contrast agent must be billed separately using appropriate HCPCS codes (such as Q9967 for low osmolar contrast or A4644 for supply in certain settings). Failure to bill contrast separately results in significant revenue loss, typically $50-150 per procedure depending on the type and volume used.

When should I use modifier 26 with CPT 72265?

Use modifier 26 when billing only the professional component (physician interpretation and report) of the myelography, typically in hospital or facility settings where the facility owns the equipment and employs technical staff. The facility bills the technical component (TC modifier) separately. If you own the equipment and provide both professional and technical services, bill 72265 without a modifier for the global service.

What diagnosis codes support medical necessity for CPT 72265?

Common supporting diagnoses include M51.06-M51.07 (lumbar disc disorders with radiculopathy), M48.06 (lumbar spinal stenosis), M54.16-M54.17 (lumbar radiculopathy), G89.29 (chronic pain), and Z88.0 (allergy to contrast media when explaining why CT myelography used instead of MRI). Documentation must clearly establish why myelography is necessary when MRI is the standard imaging modality.

How many RVUs is CPT code 72265 worth in 2025?

CPT 72265 has a total RVU value of 3.24 in 2025, consisting of 0.83 work RVUs, 2.36 practice expense RVUs (both facility and non-facility), and 0.05 malpractice RVUs. These RVU values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.