CPT 73220Radiology

Mri uppr extremity w/o&w/dye

CPT code 73220 covers an MRI scan of the upper extremity (shoulder, arm, elbow, wrist, or hand) performed both without contrast dye and then with contrast dye injected during the same session. This two-phase imaging provides detailed views to diagnose injuries, tumors, infections, or other abnormalities.

Showing rates for

National Average

Base Medicare rate

$402.07

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

2.15

PE RVU (NF)

10.12

MP RVU

0.16

Total RVU

12.43

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Always append laterality modifiers (LT/RT) even though not required by Medicare
Impact: Prevents processing delays and denials from commercial payers; reduces claim rejection rate by approximately 15-20%
Document specific medical necessity for contrast administration in the ordering physician's notes
Impact: Essential for payment; lack of contrast justification is the #1 reason for downcoding to 73218 (without contrast), reducing reimbursement by approximately $100-150
Verify that both pre-contrast and post-contrast sequences were actually performed and documented in technical parameters
Impact: Auditors specifically look for documentation of both phases; missing documentation can trigger recoupment of $402.07 per case
Do not bill 73220 with separate contrast injection codes (96374 or contrast supply codes)
Impact: Contrast administration is included in 73220; unbundling risks denial and potential fraud investigation
Ensure authorization includes the 'with and without contrast' specification, not just 'MRI upper extremity'
Impact: Pre-authorization for wrong code leads to 30-40% denial rate; requires appeal process adding 45-60 days to payment
Use specific ICD-10 codes that support contrast necessity (neoplasm, infection, inflammatory conditions) rather than generic pain codes
Impact: Pain-only diagnoses (M25.5xx) result in 25-35% higher denial rates; specific diagnoses improve first-pass payment rate

Common denials

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 73220?

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 73220 in 2025?

The 2025 Medicare national average reimbursement for CPT 73220 is $402.07 for both facility and non-facility settings. This rate is based on 12.43 total RVUs (2.15 work RVU, 10.12 practice expense RVU, 0.16 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 73220 and 73218?

CPT 73218 is MRI of the upper extremity without contrast material only, while 73220 includes imaging both without contrast AND with contrast material administered during the same session. Code 73220 requires documentation of medical necessity for the additional contrast phase and reimburses approximately $100-150 more than 73218.

Can I bill CPT 73220 with an injection code for the contrast administration?

No, contrast administration is included in CPT 73220 and cannot be billed separately. Do not report injection codes (such as 96374) or contrast supply codes with 73220, as this constitutes unbundling and may result in denials or fraud allegations.

Does CPT 73220 require prior authorization from Medicare or commercial payers?

Medicare typically does not require prior authorization for 73220, but many Medicare Advantage and commercial plans do require authorization for advanced imaging. Always verify authorization requirements with the specific payer, and ensure the authorization specifically includes 'with and without contrast' specification to prevent denials.

What diagnosis codes support medical necessity for CPT 73220?

Diagnosis codes supporting contrast use include suspected or known neoplasms (C40.xx, D16.xx, D48.0), osteomyelitis (M86.xx), septic arthritis (M00.xx), inflammatory arthropathies (M05.xx-M07.xx), and soft tissue masses requiring characterization (M79.89). Generic pain codes (M25.5xx) alone typically do not support medical necessity for contrast administration.

How many RVUs is CPT code 73220 worth in 2025?

CPT 73220 has a total of 12.43 RVUs in 2025, consisting of 2.15 work RVUs, 10.12 practice expense RVUs (both facility and non-facility), and 0.16 malpractice RVUs. This makes it a moderately valued imaging procedure in the radiology fee schedule.

Can CPT 73220 be billed bilaterally for both upper extremities?

Yes, when MRI of both upper extremities is performed with and without contrast, bill 73220 twice with RT and LT modifiers, or use modifier 50 (bilateral) if the payer accepts it. However, bilateral imaging requires separate medical necessity documentation for each extremity, and many payers will deny the second side without compelling clinical justification.