CPT 73218Radiology

Mri upper extremity w/o dye

CPT code 73218 covers an MRI scan of the upper arm, shoulder, elbow, wrist, or hand performed without using contrast dye (injected material that helps highlight certain tissues).

Showing rates for

National Average

Base Medicare rate

$296.29

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

1.35

PE RVU (NF)

7.72

MP RVU

0.09

Total RVU

9.16

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, as bilateral upper extremity MRIs require separate coding for each side
Impact: Prevents automatic denials and delays; laterality modifiers are required by most payers for extremity imaging
Verify prior authorization before scheduling, as 73218 is commonly subject to pre-certification requirements by Medicare Advantage and commercial payers
Impact: Prevents denials averaging $296.29 per claim; pre-auth compliance can reduce denial rates by 70-85%
Document medical necessity clearly linking the specific upper extremity region studied to clinical indication; avoid generic orders for 'arm pain'
Impact: Reduces medical necessity denials which account for 35-40% of MRI claim rejections
For split billing scenarios, ensure 26 and TC modifiers are applied correctly and billed by appropriate entities to prevent duplicate claim edits
Impact: Prevents claim rejections and recoupment actions; ensures proper payment distribution between facility and professional fees
Check LCD/NCD policies for specific diagnostic codes that support medical necessity in your MAC jurisdiction, as accepted indications vary regionally
Impact: Compliance with local coverage determinations can improve clean claim rates by 25-30%
When converting from with-contrast to without-contrast studies, document the clinical rationale for protocol modification in the radiology report
Impact: Prevents downcoding disputes and supports appropriate reimbursement when clinical circumstances change

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 73218 in 2025?

The 2025 Medicare national average payment rate for CPT 73218 is $296.29 for both facility and non-facility settings, based on 9.16 total RVUs and the conversion factor of 32.3465.

Does CPT 73218 require a modifier for left or right arm?

Yes, CPT 73218 requires laterality modifiers RT (right) or LT (left) to indicate which upper extremity was imaged. Omitting these modifiers commonly results in claim denials or requests for additional information.

What is the difference between CPT 73218 and 73220?

CPT 73218 is an MRI of the upper extremity without contrast dye, while 73220 is the same study performed with contrast material administered intravenously. The choice depends on clinical indication and the tissue characteristics being evaluated.

Can I bill CPT 73218 for both shoulders on the same day?

Yes, when bilateral upper extremity MRIs are medically necessary, bill 73218 twice with RT modifier for the right shoulder and LT modifier for the left shoulder on separate claim lines. Some payers may require modifier 59 to prevent bundling.

Does CPT 73218 require prior authorization from Medicare?

Traditional Medicare typically does not require prior authorization for 73218, but Medicare Advantage plans commonly do require pre-certification. Additionally, some jurisdictions participate in the Appropriate Use Criteria program requiring consultation with clinical decision support mechanisms.

How many RVUs is CPT code 73218 worth?

CPT 73218 has 9.16 total RVUs for 2025, consisting of 1.35 work RVUs, 7.72 practice expense RVUs (both facility and non-facility), and 0.09 malpractice RVUs.

What diagnosis codes support medical necessity for CPT 73218?

Commonly accepted diagnoses include rotator cuff tears (M75.1xx), shoulder pain (M25.51x), wrist fractures (S62.xxx), ligament injuries (S43.xxx, S53.xxx, S63.xxx), masses/tumors, osteomyelitis, avascular necrosis, and inflammatory arthropathies. Always verify current LCD requirements for your MAC jurisdiction.