CPT 73223Radiology

Mri joint upr extr w/o&w/dye

CPT code 73223 is for an MRI scan of an upper extremity joint (shoulder, elbow, wrist, or hand) performed twice—once without contrast dye and once with contrast dye injected to highlight structures.

Showing rates for

National Average

Base Medicare rate

$378.45

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)

9.4

MP RVU

0.15

Total RVU

11.7

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

NCCI bundling edits

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Billing tips

Verify contrast administration was actually performed and documented before billing 73223 instead of 73221 (without contrast) or 73222 (with contrast only)
Impact: 73223 reimburses $378.45 vs potentially lower rates for single-phase studies; incorrect coding can trigger audits and recoupment
Document specific joint imaged (shoulder, elbow, wrist, hand) and medical necessity for both pre- and post-contrast sequences in radiology report
Impact: Prevents medical necessity denials which account for 35-40% of MRI claim rejections; ensures compliance with LCD requirements
Confirm authorization/precertification completed before study as most payers require prior authorization for MRI with contrast
Impact: Prevents 100% payment denial; retroactive authorizations rarely approved resulting in full patient financial responsibility
Bill with appropriate laterality modifier (RT/LT) even though not required by Medicare; many commercial payers mandate anatomic modifiers
Impact: Prevents initial denials requiring corrected claims which delay payment 30-45 days; some payers auto-deny without laterality
Ensure contrast type, dose, and administration route documented when billing with diagnosis codes suggesting allergic history or renal impairment
Impact: Prevents medical necessity denials when pre-medication protocols or alternative contrast agents used; supports medical decision-making
Review CPT code family carefully - 73223 is for single joint; do not use for multiple joints (bill each joint separately with modifier 59)
Undercoding multiple joints loses $378.45 per additional joint; overcoding single joint as multiple triggers fraud alerts

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 73223 in 2025?

The 2025 Medicare national average payment rate for CPT 73223 is $378.45 for both facility and non-facility settings. This rate is based on 11.7 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 73221, 73222, and 73223?

CPT 73221 is MRI of an upper extremity joint without contrast material. CPT 73222 is with contrast material only. CPT 73223 is performed without contrast followed by with contrast and further sequences. Code 73223 represents a dual-phase study providing both non-enhanced and enhanced imaging, typically reimbursed at a higher rate than single-phase studies.

Does CPT 73223 require prior authorization?

Most Medicare Advantage plans and commercial insurance payers require prior authorization for CPT 73223. Traditional Medicare does not require prior authorization but does require compliance with appropriate use criteria under PAMA. Failure to obtain required authorization typically results in claim denial and patient financial responsibility.

How many RVUs is CPT code 73223 worth?

CPT 73223 has 11.7 total RVUs for 2025, consisting of 2.15 work RVUs, 9.4 practice expense RVUs (both facility and non-facility), and 0.15 malpractice RVUs. This RVU value reflects the resource intensity of performing dual-phase MRI imaging with contrast administration.

Can you bill CPT 73223 for bilateral upper extremity joints?

Yes, but you must bill 73223 twice with appropriate laterality modifiers (RT for right, LT for left) and modifier 59 on the second line to indicate distinct anatomic sites. Each joint is coded separately. Do not use modifier 50 (bilateral) as this code represents imaging of a single joint.

What diagnosis codes support medical necessity for CPT 73223?

Common supporting diagnoses include rotator cuff tears (M75.1xx), shoulder labral lesions (S43.43x), osteoarthritis requiring surgical planning (M19.0x-M19.2x), osteonecrosis (M87.0x-M87.3x), soft tissue masses requiring characterization (M79.89), suspected infection/osteomyelitis (M86.xx), and post-operative complications. The specific diagnosis must justify the need for contrast enhancement.

What are the documentation requirements to prevent audits of CPT 73223?

Critical documentation includes: specific joint identification, medical necessity for both contrast phases, contrast agent type and dose, administration time and route, complete imaging protocol with pre- and post-contrast sequences listed, radiologist interpretation addressing enhancement patterns, and clinical indication justifying contrast over non-contrast study. Missing contrast documentation is the leading cause of downcoding audits.