X-ray exam of shoulder
CPT code 73020 covers a standard x-ray examination of the shoulder, typically involving one or more views to evaluate bone structure, joint alignment, and potential injuries or abnormalities.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Always append RT or LT modifier to specify which shoulder was imaged, as this is required by most Medicare contractors and commercial payers
Impact: Prevents automatic denials and reduces processing delays by 15-20 days on average
Split bill using modifier 26 and TC when professional and technical components are performed by different entities to maximize compliant reimbursement
Impact: Ensures both components are paid correctly; billing globally when you only provided one component results in 100% payment clawback during audits
Document medical necessity clearly in the order and report, linking to specific ICD-10 codes for trauma, pain, or follow-up indications
Impact: Reduces medical necessity denials by approximately 30% and supports the $21.03 reimbursement during pre-payment review
When billing for both shoulders on the same date, bill 73020-RT and 73020-LT-59 to indicate distinct anatomical sites and avoid duplicate claim denials
Impact: Secures payment for both sides totaling $42.06 instead of single-side payment of $21.03
For facility billing, ensure Place of Service (POS) code is accurate (22 for outpatient hospital, 11 for office) as this affects both facility rate and compliance
Impact: Incorrect POS can trigger recoupment; both facility and non-facility rates are $21.03 for this code, but POS accuracy prevents audit flags
Submit claims within 30 days of service when possible, as timely filing is critical and some payers have stricter windows for radiology services
Impact: Prevents timely filing denials that result in complete payment loss of $21.03 per study with no appeal option after deadline
Common denials
Missing or incorrect laterality modifier (RT/LT not appended)
How to appeal: Resubmit claim with corrected modifier if within timely filing limits. Include documentation from radiology report showing which shoulder was imaged. For appeals beyond correction window, submit written appeal with operative/imaging report highlighting anatomical side and explanation of billing error.
Medical necessity not established - payer determines imaging was not warranted based on diagnosis code submitted
How to appeal: Submit appeal with complete clinical documentation including physician order with clinical indication, patient history notes showing symptoms or trauma mechanism, and relevant prior treatment records. Include LCD/NCD coverage guidelines showing submitted diagnosis codes meet criteria. Consider updating to more specific ICD-10 code if available.
Duplicate claim denial when bilateral shoulders imaged same day without proper modifier usage
How to appeal: Appeal with radiology report clearly showing both shoulders were imaged. Explain that second claim should have included modifier 59 to indicate distinct procedural service. Request reprocessing of second claim with corrected coding showing 73020-LT-59.
Global billing denial when only one component (professional or technical) was actually provided by billing entity
How to appeal: This is typically not appealable as it represents incorrect coding. If technical component was provided by hospital and professional by separate radiologist, resubmit with appropriate modifier 26 or TC. Include contractual agreements or documentation showing component split arrangement between entities.
Frequently asked questions
What is the Medicare reimbursement rate for CPT code 73020 in 2025?
The 2025 Medicare national average reimbursement for CPT 73020 is $21.03 for both facility and non-facility settings. This rate is based on 0.65 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic location based on locality adjustments.
How many RVUs is CPT code 73020 worth?
CPT 73020 has a total RVU value of 0.65, consisting of 0.15 work RVU, 0.48 practice expense RVU (both facility and non-facility), and 0.02 malpractice RVU according to the 2025 Medicare Physician Fee Schedule.
Do I need a modifier when billing CPT 73020 for shoulder x-rays?
Yes, you must append either RT (right) or LT (left) modifier to specify which shoulder was imaged, as this is required by most payers for anatomical specificity. Additionally, use modifier 26 for professional component only or TC for technical component only if billing components separately.
Can I bill CPT 73020 for both shoulders on the same day?
Yes, you can bill for bilateral shoulder x-rays by submitting 73020-RT for the right shoulder and 73020-LT-59 for the left shoulder. The modifier 59 on the second shoulder prevents duplicate claim denials and indicates a distinct procedural service, allowing reimbursement for both examinations.
What is the difference between CPT 73020 and 73030?
CPT 73020 is a standard shoulder x-ray with a minimum of one view, while CPT 73030 is a complete shoulder x-ray examination requiring a minimum of two views. The number of views obtained and documented determines which code to use, with 73030 providing higher reimbursement for the more comprehensive study.
What diagnosis codes support medical necessity for CPT 73020?
Common supporting diagnosis codes include M25.511-M25.512 (shoulder pain), S42.001A-S42.92XA (shoulder fractures), M19.011-M19.012 (shoulder osteoarthritis), M75.100-M75.122 (rotator cuff disorders), and S43.001A-S43.406A (shoulder dislocations). Always link the most specific diagnosis code available based on clinical documentation.
How often can CPT 73020 be billed for the same patient?
There is no specific Medicare frequency limitation for 73020, but medical necessity must be documented for each examination. Repeat imaging should be justified by clinical change, follow-up of known pathology, treatment monitoring, or new trauma. Frequent billing without documented clinical indication may trigger medical review or audit.