CPT 73560Radiology

X-ray exam of knee 1 or 2

CPT code 73560 covers a basic knee X-ray examination with one or two different views taken to evaluate knee pain, injury, or abnormalities. This is one of the most common diagnostic imaging procedures ordered in orthopedic and primary care settings.

Showing rates for

National Average

Base Medicare rate

$32.99

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

0.16

PE RVU (NF)

0.84

MP RVU

0.02

Total RVU

1.02

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

NCCI bundling edits

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Billing tips

Count views carefully before coding - if 3 or more views are taken, use 73562 instead of 73560
Impact: Using 73562 (3+ views) reimburses at $39.77 vs $32.99 for 73560, a $6.78 difference per study (21% higher reimbursement)
Document laterality in both the order and the report to support RT/LT modifiers and prevent denials
Impact: Prevents 10-15% of denials related to missing or unclear laterality documentation
Split professional and technical components appropriately when services are performed in different settings
Impact: Ensures correct payment when interpretation is done by outside radiologist or in facility vs non-facility settings
Link appropriate ICD-10 diagnosis codes that support medical necessity - traumatic injury codes (S-codes) or M-codes for arthritis/chronic conditions
Impact: Reduces denial rate by 20-30% when specific diagnosis codes match the clinical indication documented in the order
For bilateral knee X-rays, verify payer policy on modifier 50 vs billing 73560 twice with RT/LT modifiers
Impact: Some payers reimburse bilateral at 150% of single rate with modifier 50, while others require separate line items; incorrect billing can reduce payment by 50%
Ensure the radiologist's report documents the number of views interpreted and explicitly states 1 or 2 views were evaluated
Impact: Audit protection and appeal support; vague documentation contributes to 25% of post-payment audit takebacks for this code

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 73560 in 2025?

The 2025 Medicare national average reimbursement for CPT 73560 is $32.99 for both facility and non-facility settings. This rate is based on 1.02 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the Medicare Geographic Practice Cost Index (GPCI).

What is the difference between CPT 73560 and 73562?

CPT 73560 is for knee X-rays with 1 or 2 views, while CPT 73562 covers 3 or more views. The view count determines which code to use: 1-2 views = 73560 ($32.99), 3 or more views = 73562 ($39.77). Count all distinct projections documented in the technologist worksheet and radiologist report to select the correct code.

Do I need a modifier when billing 73560 for both knees?

Yes, laterality modifiers are required. For bilateral knee X-rays, you can either use modifier 50 (bilateral) on one line or bill 73560 twice with RT (right) and LT (left) modifiers on separate lines. Check your specific payer's policy, as some prefer modifier 50 while others require separate line items. Medicare typically accepts either approach.

How many RVUs is CPT code 73560 worth in 2025?

CPT 73560 has a total of 1.02 RVUs in 2025, consisting of 0.16 work RVUs, 0.84 practice expense RVUs, and 0.02 malpractice RVUs. These are the same for both facility and non-facility settings, which is uncommon but reflects the standardized nature of basic X-ray imaging.

Can CPT 73560 be billed with an office visit on the same day?

Yes, CPT 73560 can be billed with an evaluation and management (E/M) code on the same day without modifier 25. Modifier 25 is used with E/M codes, not with diagnostic procedures like X-rays. Simply ensure the E/M service is separately documented and medically necessary beyond the decision to order the X-ray.

What diagnosis codes are commonly used with CPT 73560?

Common ICD-10 codes include M25.561/M25.562 (knee pain), S83.4XXA (sprain of knee), M17.11/M17.12 (unilateral primary osteoarthritis of knee), M23.XX (internal knee derangement), S82.XXA (fracture of lower leg including knee), and R26.2 (difficulty walking). The diagnosis must support medical necessity for the imaging study.

How often can CPT 73560 be billed for the same patient?

There is no specific Medicare frequency limitation for 73560, but medical necessity must be documented for each service. Repeated imaging within a short timeframe may trigger review. Typical medically necessary scenarios include follow-up after trauma (6-8 weeks for fracture healing), monitoring chronic conditions (every 6-12 months for arthritis progression), or evaluation of new symptoms. Document clinical justification clearly for repeat studies.