CPT 73202Radiology

Ct uppr extremity w/o&w/dye

CPT 73202 covers a CT scan of the upper extremity (shoulder, arm, elbow, forearm, wrist, or hand) performed twice: once without contrast dye and again with contrast dye injected into a vein. This provides detailed imaging to evaluate bones, soft tissues, blood vessels, and abnormalities.

Showing rates for

National Average

Base Medicare rate

$242.28

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

1.22

PE RVU (NF)

6.19

MP RVU

0.08

Total RVU

7.49

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

NCCI bundling edits

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Billing tips

Verify that both non-contrast and contrast phases were actually performed and documented before billing 73202
Impact: Prevents downcoding to 73201 (without contrast only) which reimburses approximately $50-70 less, or 73200 (without dye) at even lower rates
Confirm contrast administration documentation includes type, dose, route, and time of injection in the radiology report
Impact: Absence of contrast documentation triggers automatic denials or downcoding in approximately 15-20% of audits
Ensure medical necessity is clearly documented for requiring both phases, particularly for Medicare patients
Impact: Medicare LCD policies require specific clinical indications for contrast; failure to document can result in full claim denial of $242.28
When performed in non-facility setting, verify correct place of service code (11 or 22) to receive full non-facility rate
Impact: Incorrect POS code can trigger facility rate payment, though in this case both rates are identical at $242.28
Review payer-specific policies regarding bundling with other upper extremity imaging performed same day
Impact: Unbundling violations can trigger recoupment of 50-100% of payment plus potential fraud investigation
For bilateral upper extremity CT scans, append modifier 50 or bill twice with RT/LT modifiers per payer preference
Impact: Proper bilateral coding ensures payment for both sides; improper coding risks 50% payment reduction or denial

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 73202 in 2025?

The 2025 Medicare national average payment rate for CPT 73202 is $242.28 for both facility and non-facility settings. This rate is based on 7.49 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

What is the difference between CPT 73200, 73201, and 73202?

CPT 73200 is CT upper extremity without contrast only, 73201 is with contrast only, and 73202 is without contrast followed by with contrast (dual-phase study). Code 73202 requires both phases to be performed and documented, providing the most comprehensive imaging but at higher cost.

How many RVUs is CPT code 73202 worth?

CPT 73202 has 7.49 total RVUs for 2025, consisting of 1.22 work RVUs, 6.19 practice expense RVUs (both facility and non-facility), and 0.08 malpractice RVUs according to the CMS Physician Fee Schedule.

Can CPT 73202 be billed bilaterally?

Yes, if CT scans of both upper extremities are performed with the dual-phase protocol, you can bill 73202 twice with RT and LT modifiers, or once with modifier 50, depending on payer requirements. Documentation must support medical necessity for bilateral imaging.

What diagnosis codes support medical necessity for CPT 73202?

Common supporting diagnoses include soft tissue masses/tumors, osteomyelitis, complex trauma requiring soft tissue evaluation, suspected vascular abnormalities, inflammatory arthropathies, and malignancy staging. Specific ICD-10 code requirements vary by payer LCD/NCD policies.

Do I need prior authorization for CPT 73202?

Many commercial payers and Medicare Advantage plans require prior authorization for advanced imaging including CT with contrast. Medicare traditional does not require prior auth but has medical necessity requirements. Always verify specific payer policies before scheduling.

Can CPT 73202 be billed with an E/M code on the same day?

Yes, an E/M service can be billed with 73202 if the E/M represents a separately identifiable service beyond the order for imaging. The radiologist's interpretation is included in 73202 and cannot be separately billed as an E/M. The ordering physician may bill an appropriate E/M with modifier 25 if documented criteria are met.