CPT 73219Radiology

Mri upper extremity w/dye

CPT code 73219 covers an MRI scan of the upper extremity (shoulder, arm, elbow, wrist, or hand) performed with contrast dye injected into a vein to enhance image quality and help identify abnormalities.

Showing rates for

National Average

Base Medicare rate

$324.44

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

1.62

PE RVU (NF)

8.31

MP RVU

0.1

Total RVU

10.03

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

NCCI bundling edits

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Billing tips

Always verify contrast administration was actually performed and documented before using 73219 instead of 73218 (without contrast)
Impact: Incorrect code selection can result in overpayment recovery of approximately $50-80 per claim during audits
Split bill using modifier 26 and TC when professional and technical components are performed by different entities
Impact: Ensures both parties receive appropriate reimbursement without claim rejections for duplicate billing
Document medical necessity for contrast enhancement in the ordering physician's notes and radiologist's report
Impact: Reduces denial rate by 60-70% for medical necessity reviews; contrast studies face higher scrutiny than non-contrast
Verify LCD/NCD compliance for contrast use - Medicare requires specific indications for contrast-enhanced MRI
Impact: Non-compliant orders result in denials of the entire $324.44 payment with difficult appeal prospects
Use specific anatomic codes - bill 73221 for MRI joint with contrast when imaging a specific joint rather than entire extremity
Impact: Joint-specific codes may have different reimbursement rates and medical necessity criteria
Include laterality modifier (RT/LT) on all claims even when payer doesn't require it
Impact: Prevents processing delays and appeals that cost an average of 45-60 days in delayed payment

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 73219 in 2025?

The 2025 Medicare national average payment rate for CPT 73219 is $324.44 for both facility and non-facility settings. This rate is based on 10.03 total RVUs multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 73218 and 73219?

CPT 73218 is MRI of the upper extremity without contrast, while 73219 includes intravenous contrast material administration. Code 73219 requires documentation that contrast was medically necessary and actually administered. The contrast-enhanced study (73219) receives higher reimbursement due to additional supplies and increased complexity.

How many RVUs is CPT code 73219 worth?

CPT 73219 has 10.03 total RVUs for 2025, consisting of 1.62 work RVUs, 8.31 practice expense RVUs (both facility and non-facility), and 0.10 malpractice RVUs according to the CMS Physician Fee Schedule.

Does CPT 73219 require prior authorization?

Prior authorization requirements vary by payer. Most Medicare Advantage plans and many commercial insurers require prior authorization for MRI procedures including 73219. Original Medicare typically does not require prior auth but does require medical necessity documentation. Always verify with the specific payer before scheduling.

Can you bill CPT 73219 with modifier 26?

Yes, modifier 26 should be appended to 73219 when billing only the professional component (physician interpretation). This is common when a radiologist interprets an MRI performed at a facility they don't own. The facility bills with modifier TC for the technical component.

What diagnosis codes support medical necessity for CPT 73219?

Common supporting ICD-10 codes include M75.100-M75.122 (rotator cuff tear), S43.001A-S43.499A (shoulder injuries), M25.511-M25.579 (joint pain), C40.00-C40.92 (bone malignancies), and D48.0 (soft tissue neoplasm). The specific diagnosis must justify why contrast enhancement is necessary rather than a non-contrast study.

How do you bill for bilateral upper extremity MRI with contrast?

Bill CPT 73219 twice with RT modifier on one line and LT modifier on the other line, or use modifier 50 for bilateral procedure depending on payer preference. However, bilateral upper extremity MRIs on the same day are frequently subject to medical necessity review, so documentation must clearly justify imaging both sides.