CPT 73201Radiology

Ct upper extremity w/dye

CPT code 73201 is used when a radiologist performs a CT scan of the arm, shoulder, or hand using contrast dye (injected into a vein) to create detailed images that help diagnose injuries, tumors, or infections.

Showing rates for

National Average

Base Medicare rate

$196.67

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

1.16

PE RVU (NF)

4.85

MP RVU

0.07

Total RVU

6.08

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

NCCI bundling edits

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Billing tips

Verify contrast administration documentation is explicit in the report, including type, amount, and route of contrast agent used
Impact: Missing contrast documentation can result in downcoding to 73200 (without contrast), reducing reimbursement by approximately $35-50
Ensure medical necessity is clearly documented with specific ICD-10 codes that support contrast-enhanced imaging rather than non-contrast study
Impact: Payers may deny or downcode to non-contrast study if diagnosis codes don't justify contrast use, affecting 20-30% of reimbursement
Bill global code 73201 only when both professional and technical components are performed by the same entity; split bill with 26/TC modifiers when appropriate
Impact: Incorrect component billing can result in overpayment recoveries or underpayment; proper split ensures accurate $196.67 total reimbursement allocation
Verify no pre-authorization or prior authorization requirements before performing study; many commercial payers require advance imaging authorization
Impact: Lack of prior authorization is the leading cause of denial for CT studies, potentially resulting in 100% claim denial or patient balance responsibility
Document anatomic specificity in operative report—identify exact upper extremity location (shoulder vs. forearm vs. hand) to support medical necessity
Impact: Vague anatomic descriptions increase audit risk and can trigger medical review, delaying payment by 30-60 days
Review National Coverage Determination (NCD) and Local Coverage Determination (LCD) policies for CT upper extremity imaging in your MAC jurisdiction

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 73201 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 73201 is $196.67 for both facility and non-facility settings. This is based on a total RVU of 6.08 multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 73200 and 73201?

CPT 73200 is a CT scan of the upper extremity without contrast material, while CPT 73201 includes intravenous contrast administration. Code 73201 reimburses higher due to the additional contrast agent cost and medical complexity. The choice between codes depends on clinical indication and medical necessity for contrast enhancement.

Does CPT 73201 require a modifier for left or right arm?

While CPT 73201 does not inherently require laterality modifiers (RT/LT) for Medicare, many commercial payers do require these modifiers to specify which upper extremity was imaged. Best practice is to append RT or LT modifiers to prevent potential denials and ensure clear documentation of the anatomic location.

Can CPT 73201 be billed with an E/M code on the same day?

Yes, CPT 73201 can be billed with an evaluation and management (E/M) code on the same day when the E/M service is separately identifiable and medically necessary. The E/M code should include modifier 25 to indicate a significant, separately identifiable service. Documentation must support both services independently.

What are the work RVUs for CPT code 73201?

CPT 73201 has 1.16 work RVUs in 2025. The total RVU is 6.08, which includes 1.16 work RVUs, 4.85 practice expense RVUs, and 0.07 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Does CPT 73201 require prior authorization for Medicare?

Traditional Medicare typically does not require prior authorization for CPT 73201, though some Medicare Advantage plans do require it. However, as of 2025, certain imaging services may be subject to appropriate use criteria under the Protecting Access to Medicare Act (PAMA). Always verify specific payer requirements before scheduling.

How should I bill if both upper extremities are scanned with contrast?

When bilateral upper extremity CT scans with contrast are performed, bill CPT 73201 twice with modifiers RT and LT (or modifier 50 for bilateral if payer accepts it). Documentation must support medical necessity for imaging both extremities. Some payers may apply a bilateral discount of 50% to the second extremity, so verify payer-specific billing rules.