CPT 73060Radiology

X-ray exam of humerus

CPT code 73060 covers an X-ray examination of the humerus, which is the long bone in your upper arm between the shoulder and elbow. This imaging test helps doctors diagnose fractures, bone disease, or other abnormalities in the upper arm bone.

Showing rates for

National Average

Base Medicare rate

$31.05

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

0.16

PE RVU (NF)

0.78

MP RVU

0.02

Total RVU

0.96

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
Impact: Prevents automatic denials from Medicare and most commercial payers who require anatomic modifiers for paired structures; can delay payment by 15-30 days if missing
Split bill between 26 and TC modifiers when facility and radiologist are different entities
Impact: Ensures both parties receive appropriate reimbursement; professional component typically $11-13, technical component $18-20 of the $31.05 total
Document minimum two views in radiology report to support complete examination
Impact: Single view may be downcoded to 73000 series limited studies, reducing reimbursement by 30-40%
Verify medical necessity diagnosis codes support imaging - acute trauma codes (S42.3xx series) have highest approval rates
Impact: Non-specific pain codes (M25.519) have 15-20% higher denial rates than specific fracture or trauma codes
Do not bill 73060 with shoulder X-rays (73030) or elbow X-rays (73070) unless clearly documenting separate clinical indications
Impact: Bundling edits may deny 73060 as inclusive; appeals require documentation of distinct anatomic areas and separate medical necessity
Check patient insurance for prior authorization requirements before scheduling
Impact: Some managed care plans require pre-auth even for basic X-rays; retroactive denials of $31.05 create write-offs and patient billing issues

Applicable modifiers

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 73060 in 2025?

The 2025 Medicare national average payment for CPT 73060 is $31.05 for both facility and non-facility settings. This rate is based on 0.96 total RVUs (0.16 work RVU, 0.78 PE RVU, 0.02 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

How many views are required to bill CPT 73060?

CPT 73060 requires a minimum of two views of the humerus, typically anteroposterior (AP) and lateral projections. Single view examinations should be coded with a limited study code. Documentation must clearly indicate the number and type of views obtained to support the complete examination code.

Can I bill CPT 73060 with a shoulder or elbow X-ray on the same day?

Yes, you can bill 73060 with shoulder X-rays (73030) or elbow X-rays (73070) if there is distinct clinical indication for each anatomic area and separate documentation. However, be aware of potential bundling edits and ensure the radiology report clearly documents separate evaluations of different anatomic regions with specific clinical indications for each.

Do I need modifier 26 or TC when billing CPT 73060?

Use modifier 26 if billing only the professional component (physician interpretation), modifier TC if billing only the technical component (equipment and technologist), or no modifier if billing the global service (both components). Hospital outpatient departments typically bill global or TC, while radiologists bill 26 for their interpretation.

Is prior authorization required for CPT 73060?

Medicare typically does not require prior authorization for basic X-ray procedures like 73060. However, many Medicare Advantage and commercial insurance plans have implemented prior authorization requirements even for basic imaging. Always verify the specific patient's insurance requirements before scheduling to avoid payment denials.

What diagnosis codes support medical necessity for CPT 73060?

Common supporting diagnosis codes include fractures of the humerus (S42.3xx series), upper arm pain (M79.621/M79.622), bone lesions or tumors, osteomyelitis, post-operative follow-up (Z47.89), and trauma evaluation (S49.9xx). Specific, detailed diagnosis codes have higher approval rates than non-specific pain or symptom codes.

What is the difference between CPT 73060 and 73070?

CPT 73060 is an X-ray examination of the humerus (upper arm bone between shoulder and elbow), while CPT 73070 is an X-ray examination of the elbow joint. The distinction is based on the specific anatomic area being evaluated. If both the humerus and elbow are clinically indicated and separately documented, both codes may be billed with appropriate modifiers.