CPT 73040Radiology

Contrast x-ray of shoulder

CPT code 73040 covers an x-ray examination of the shoulder joint using contrast material (dye) injected into the joint to better visualize internal structures like cartilage, ligaments, and the joint capsule.

Showing rates for

National Average

Base Medicare rate

$125.50

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

0.54

PE RVU (NF)

3.3

MP RVU

0.04

Total RVU

3.88

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

NCCI bundling edits

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Billing tips

Always append laterality modifiers (RT/LT) when billing 73040 as most payers require anatomic specificity for shoulder imaging
Impact: Prevents automatic denials and resubmission delays that can cost 15-30 days in payment cycle
Bill the contrast injection procedure separately using CPT 23350 (injection procedure for shoulder arthrography) when performed by the same provider
Impact: Additional reimbursement of approximately $80-100 when properly documented and billed as separate service with modifier 59 if needed
Split bill with modifier 26 and TC when professional and technical components are performed in different settings to maximize reimbursement
Impact: Ensures both facility and physician receive appropriate payment portions of the $125.50 total
Document fluoroscopic guidance time and number of images obtained as inadequate documentation is the leading cause of downcoding to standard shoulder x-ray (73030)
Impact: Prevents downcoding that would reduce reimbursement by approximately $40-50
Verify pre-authorization requirements as many commercial payers require prior approval for arthrography despite being diagnostic imaging
Impact: Prevents denials that average 60+ days to resolve and may result in patient balance billing issues
When performed same day as shoulder MRI (73221-73223), ensure separate documentation justifying medical necessity of both studies to avoid bundling
Impact: Protects combined reimbursement of $300+ when both procedures are medically necessary

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 73040 in 2025?

The 2025 Medicare national average reimbursement for CPT 73040 is $125.50 for both facility and non-facility settings. This rate is based on 3.88 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

Can CPT 73040 be billed with the shoulder injection code 23350?

Yes, CPT 73040 can be billed with 23350 (injection procedure for shoulder arthrography) when both services are performed and documented separately. The injection code should typically be reported first, and modifier 59 may be required on one code to indicate a distinct procedural service and prevent bundling denials.

Does CPT 73040 require a modifier for left or right shoulder?

Yes, laterality modifiers RT (right) or LT (left) are required when billing CPT 73040 to specify which shoulder was examined. Most Medicare contractors and commercial payers will deny or reject claims for shoulder imaging without appropriate laterality modifiers.

What is the difference between CPT 73040 and 73030?

CPT 73040 is a contrast x-ray (arthrogram) of the shoulder requiring intra-articular injection of contrast material, while CPT 73030 is a standard shoulder x-ray without contrast. The arthrogram (73040) provides enhanced visualization of soft tissues and is reimbursed at a higher rate due to the additional complexity and contrast administration.

How many RVUs is CPT code 73040 worth in 2025?

CPT 73040 has 3.88 total RVUs in 2025, consisting of 0.54 work RVUs, 3.3 practice expense RVUs (both facility and non-facility), and 0.04 malpractice RVUs according to the CMS Physician Fee Schedule.

Can CPT 73040 be billed bilaterally for both shoulders?

Yes, when bilateral shoulder arthrograms are performed, bill CPT 73040 twice with RT modifier on one line and LT modifier on the other line. Alternatively, some payers accept billing one unit with modifier 50 (bilateral procedure), though payment policies vary and may reduce the second side to 50% reimbursement.

What diagnosis codes support medical necessity for CPT 73040?

Common supporting diagnosis codes include M75.1 (rotator cuff tear), M75.3 (calcific tendinitis), M24.01 (loose body in shoulder joint), M75.0 (adhesive capsulitis), S43.43 (superior labrum lesion), and M25.51 (shoulder pain). Documentation must link the specific diagnosis to the clinical need for contrast arthrography versus standard imaging.