CPT 73020Radiology

X-ray exam of shoulder

CPT code 73020 covers a basic x-ray examination of the shoulder, typically performed to evaluate injuries, pain, or structural abnormalities in the shoulder joint.

Showing rates for

National Average

Base Medicare rate

$21.03

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

0.15

PE RVU (NF)

0.48

MP RVU

0.02

Total RVU

0.65

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

NCCI bundling edits

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Billing tips

Always append RT or LT modifier to specify laterality; this is required by most payers including Medicare and failure to include results in automatic denials
Impact: Prevents 100% of payment denials due to missing laterality; critical for claim acceptance
Verify view count before coding; if multiple views were taken (2+ views), use 73030 instead of 73020 to capture appropriate reimbursement
Impact: 73030 reimburses at $27.78 vs $21.03 for 73020—undercoding costs $6.75 per study (32% revenue loss)
When billing bilateral shoulders on same date, bill 73020-LT and 73020-RT as separate line items rather than using modifier 50
Impact: Ensures full reimbursement of $42.06 total; modifier 50 may trigger 150% payment cap instead of 200%
Document medical necessity clearly in radiology order; include specific indication such as 'trauma,' 'pain,' or 'post-operative evaluation' rather than generic 'shoulder pain'
Impact: Reduces medical necessity denials by approximately 40%; strengthens appeals when denials occur
Split technical and professional components when services are performed at separate facilities to ensure both providers receive appropriate payment
Impact: Professional component (modifier 26) pays approximately $6.10; technical component (modifier TC) pays approximately $14.93
Review payer-specific policies for global periods following shoulder surgery; some payers bundle routine post-op x-rays into surgical fee
Impact: Prevents denied claims during 10-90 day global periods; identifies when modifier 79 may be needed for new problem

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 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.

What is the difference between CPT 73020 and 73030?

CPT 73020 covers a shoulder x-ray with one view (minimum), while CPT 73030 includes a complete shoulder x-ray study with a minimum of two views. The view count documented in the radiology report determines which code to use, with 73030 reimbursing at a higher rate.

Do I need to use a modifier with CPT 73020?

Yes, you must append either modifier RT (right) or LT (left) to CPT 73020 to indicate which shoulder was imaged. Most payers including Medicare require laterality modifiers for all paired anatomical structures, and claims will be denied without them.

Can CPT 73020 be billed bilaterally on the same date?

Yes, when both shoulders are x-rayed on the same date, bill CPT 73020 twice on separate line items: once with modifier RT and once with modifier LT. This ensures full reimbursement for both sides ($42.06 total) rather than reduced bilateral pricing.

What RVU value is assigned to CPT 73020 in 2025?

CPT 73020 has a total RVU of 0.65 in 2025, consisting of 0.15 work RVU, 0.48 practice expense RVU, and 0.02 malpractice RVU. These values are the same for both facility and non-facility settings.

What diagnosis codes support medical necessity for CPT 73020?

Common supporting ICD-10 codes include M25.511-512 (shoulder pain), S43 codes (shoulder dislocation/sprain), S42 codes (shoulder/upper arm fracture), M19.01 (shoulder osteoarthritis), and M75 codes (shoulder lesions). The diagnosis must justify the need for imaging.

Can CPT 73020 be billed with an E/M service on the same day?

Yes, CPT 73020 can be billed with an E/M service on the same day as they are separate and distinct services. The x-ray is a diagnostic test and does not bundle with evaluation and management codes. Ensure both services are medically necessary and properly documented.