CPT 73206Radiology

Ct angio upr extrm w/o&w/dye

CPT code 73206 represents a CT angiography scan of the upper extremity (arm, shoulder, or hand) performed twice—once without contrast dye and once with contrast dye injected into the veins to highlight blood vessels.

Showing rates for

National Average

Base Medicare rate

$292.74

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

1.81

PE RVU (NF)

7.1

MP RVU

0.14

Total RVU

9.05

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Always verify patient's renal function (creatinine/eGFR) is documented within 30 days prior to contrast administration, as this is frequently audited and missing documentation leads to denials
Impact: Prevents denials worth $292.74 per claim and reduces medical liability exposure
Document the medical necessity for BOTH non-contrast and contrast phases - simply ordering 'with and without' is insufficient; specify why dual-phase imaging is required over single-phase
Impact: Prevents downcoding to 73202 (without contrast only) which pays significantly less, protecting $50-75 in revenue per case
Bill separately from same-day chest CT angiography (71275) using modifier 59 when both are medically necessary, as these are commonly bundled by payers despite being separate anatomic territories
Impact: Preserves full $292.74 reimbursement instead of bundle adjustment reduction of 50% or complete denial
Ensure the radiologist's report explicitly describes findings in both pre-contrast and post-contrast phases to support the dual-phase billing; generic template reports trigger audits
Impact: Reduces audit risk and supports full reimbursement during post-payment review
Verify authorization requirements before scheduling - many commercial payers require pre-authorization for CTA procedures, and retroactive authorization is often denied
Impact: Prevents complete claim denial; authorization denials result in $0 reimbursement and patient liability issues
When billing the professional component (modifier 26), ensure the interpretation addresses vascular pathology specifically; musculoskeletal-only interpretations may be downcoded to standard CT

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 73206?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 73206 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 73206 is $292.74 for both facility and non-facility settings. This rate is based on a total of 9.05 RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic location and local Medicare Administrative Contractor (MAC) adjustments.

Does CPT 73206 require prior authorization from Medicare or commercial payers?

Medicare typically does not require prior authorization for 73206, though some Medicare Advantage plans do. Most commercial payers require pre-authorization for CTA procedures as advanced imaging. Authorization requirements vary by payer and patient plan, so verification before scheduling is essential to avoid claim denials.

What is the difference between CPT 73206 and 73202?

CPT 73206 includes imaging both without and with contrast (dual-phase protocol), while CPT 73202 is performed without contrast only. Code 73206 requires IV contrast administration and captures both pre-contrast and post-contrast images, making it appropriate for vascular evaluation. Code 73202 is used when only non-contrast imaging is medically appropriate or when contrast is contraindicated.

Can CPT 73206 be billed bilaterally with modifier 50?

No, CPT 73206 should not be billed with modifier 50 (bilateral procedure). If bilateral upper extremity CTA is required, bill 73206 twice with RT and LT modifiers to indicate right and left sides separately. Most payers will process both claims, though the second study may require additional medical necessity documentation.

What diagnosis codes support medical necessity for CPT 73206?

Common supporting diagnoses include I77.1 (stricture of artery), I74.2 (embolism/thrombosis of upper extremity arteries), I65.2 (subclavian artery occlusion), G54.0 (thoracic outlet syndrome), Q27.30 (arteriovenous malformation), and S45-S55 codes (injury to blood vessels of upper extremity). Documentation must clearly link the diagnosis to the clinical presentation and justify why CTA imaging is necessary.

How many RVUs is CPT code 73206 worth in 2025?

CPT 73206 has a total of 9.05 RVUs in 2025, consisting of 1.81 work RVUs, 7.1 practice expense RVUs (both facility and non-facility), and 0.14 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

What documentation is required to bill CPT 73206 for the professional component?

To bill 73206 with modifier 26 (professional component), the radiologist must provide a complete interpretation report that describes findings on both the non-contrast and contrast-enhanced phases, addresses the clinical indication, identifies vascular anatomy and any pathology, and provides a clinical impression. The report must be signed and dated by the interpreting physician and demonstrate the medical necessity for dual-phase imaging.