CPT 73200Radiology

Ct upper extremity w/o dye

CPT 73200 is the billing code for a CT scan of the upper extremity (arm, shoulder, elbow, wrist, or hand) performed without contrast dye. This is a diagnostic imaging test that creates detailed cross-sectional pictures to evaluate bones, soft tissues, and joints.

Showing rates for

National Average

Base Medicare rate

$158.17

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

PE RVU (NF)

3.83

MP RVU

0.06

Total RVU

4.89

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

NCCI bundling edits

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Billing tips

Verify that contrast was truly not administered before billing 73200 instead of 73201 or 73202
Impact: Incorrect code selection can result in $40-80 payment differential and potential recoupment or fraud allegations
Always append laterality modifiers (RT/LT) to prevent automatic denials from payers requiring anatomic specificity
Impact: Prevents approximately 15-20% of initial denials that require costly resubmission and delay payment by 30-60 days
For facility billing, ensure place of service code matches actual location (22 for hospital outpatient, 24 for ASC, 11 for office)
Impact: Incorrect POS codes trigger audits and can affect payment; facility vs non-facility rates are equal at $158.17 for this code but documentation requirements differ
Document medical necessity with specific clinical indication beyond generic 'pain' - cite mechanism of injury, failed conservative treatment, or specific diagnostic questions
Impact: Strong medical necessity documentation reduces denial rate by 40-60% and supports appeals for the $158.17 payment
When billing split components (26/TC), ensure both claims reference the same date of service and anatomic location to prevent coordination of benefits issues
Impact: Mismatched component billing can delay payment by 45-90 days while payers request coordination documentation
Check payer-specific prior authorization requirements before service; many commercial payers now require pre-auth for all CT studies including 73200
Impact: Lack of prior authorization is the leading cause of denials (35-45% of all 73200 denials) and may result in complete non-payment of $158.17

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 73200 in 2025?

The 2025 Medicare national average payment rate for CPT 73200 is $158.17 for both facility and non-facility settings. This rate is based on 4.89 total RVUs (1.0 work RVU + 3.83 PE RVU + 0.06 MP RVU) multiplied by the 2025 conversion factor of $32.3465.

What is the difference between CPT 73200 and 73201?

CPT 73200 is for CT of the upper extremity without contrast dye, while CPT 73201 is for the same examination with intravenous contrast material. You cannot bill both codes for the same examination. If both non-contrast and contrast imaging are performed during the same session, use CPT 73202 (without contrast followed by with contrast).

Do I need prior authorization for CPT 73200?

Prior authorization requirements vary by payer. Medicare typically does not require prior auth for 73200, but many Medicare Advantage and commercial plans do require it as part of radiology benefit management programs. Always verify with the specific payer before scheduling the CT scan to avoid denials.

Can CPT 73200 be billed bilaterally?

CPT 73200 is a unilateral code describing one upper extremity. If bilateral CT scans are medically necessary (both arms on the same day), bill 73200 twice with RT and LT modifiers, or 73200 with modifier 50 (bilateral) if the payer accepts modifier 50 for radiology codes. Many payers require separate line items with laterality modifiers instead of modifier 50.

What diagnosis codes support medical necessity for CPT 73200?

Common supporting diagnoses include acute fractures (S42-S62 series), bone tumors (C40-C41, D16), osteomyelitis (M86), non-union or malunion of fractures (M84.0-M84.1), foreign body (M79.5), trauma (S40-S69 series), and complex regional pain syndrome (G90.5). Generic pain codes (M79.6) or arthralgia (M25.5) without supporting documentation often result in denials.

How do I bill CPT 73200 for split technical and professional components?

The technical component (equipment, technologist, supplies) is billed as 73200-TC, while the professional component (physician interpretation) is billed as 73200-26. The facility bills the TC, and the interpreting radiologist bills the 26. Both must reference the same date of service and anatomic location. The sum of TC and 26 payments equals the global $158.17 rate.

What are the RVUs for CPT code 73200 in 2025?

For 2025, CPT 73200 has a work RVU of 1.0, practice expense RVU of 3.83 (same for both facility and non-facility), and malpractice RVU of 0.06, totaling 4.89 RVUs. When multiplied by the 2025 conversion factor of $32.3465, this yields the Medicare payment of $158.17.