X-ray exam of knee 3
CPT code 73562 covers a three-view x-ray examination of the knee, which typically includes front, side, and angled images to evaluate bone and joint structures for injury, arthritis, or other abnormalities.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Always append RT or LT modifier to specify laterality - this is now a Medicare requirement for all bilateral procedures and improves claims processing accuracy
Impact: Prevents claim rejection and potential 5-10 day payment delay; required for compliance with NCCI edits
Document exact number of views in radiology report - three views must be explicitly stated to support 73562 versus 73560 (1-2 views) or 73564 (complete study)
Impact: Billing 73562 when only 2 views documented results in downcoding to 73560, losing approximately $10-15 per encounter
Verify medical necessity documentation before billing - ICD-10 codes must support the need for imaging per Medicare LCD policies
Impact: Lack of medical necessity is the #1 denial reason, affecting 15-20% of diagnostic imaging claims and risking full $39.46 denial
Use modifier 26 or TC appropriately based on your facility type - hospital outpatient departments typically bill global, while private practices may split bill
Impact: Incorrect modifier usage can result in 50-80% underpayment or complete denial requiring claim resubmission
Do not bill 73562 with 73564 on the same knee same date - 73564 is a complete study that includes the views in 73562
Impact: This is an NCCI bundling edit that will result in automatic denial of 73562, preventing double payment
For bilateral knee x-rays, bill 73562-RT and 73562-LT separately or use 73562-50 depending on payer preference
Impact: Proper bilateral billing ensures payment for both knees, increasing reimbursement from $39.46 to $78.92 for the encounter
Common denials
Medical necessity not established - payer determines the diagnosis code does not support the need for knee imaging
How to appeal: Submit clinical notes documenting patient symptoms, physical examination findings, and prior conservative treatment. Reference payer's LCD/NCD policies showing the diagnosis code is covered. Include relevant clinical guidelines from ACR Appropriateness Criteria supporting imaging for the specific indication.
Incorrect number of views documented - radiology report states only 2 views were taken but 73562 was billed
How to appeal: Review original images to confirm three views were actually obtained. If confirmed, request amended radiology report from interpreting physician explicitly listing all three views. Resubmit claim with corrected documentation. If only 2 views were taken, accept downcoding to 73560 and adjust future billing practices.
Duplicate service denial - same code billed twice on same date without proper modifiers or bilateral indicators
How to appeal: Provide documentation showing bilateral studies were performed (both knees) or that repeat imaging was medically necessary. Resubmit claim with appropriate RT/LT modifiers or modifier 76 with documentation explaining clinical reason for repeat study on same day.
Bundling edit - 73562 denied as included in another procedure billed on same date (such as 73564 or joint injection codes)
How to appeal: Review NCCI edits to determine if services are truly bundled. If imaging was distinct and separate, resubmit with modifier 59 and documentation showing the x-ray was performed at a different session or for a different clinical purpose. If truly bundled per NCCI, accept denial and adjust billing.
Frequently asked questions
What is the Medicare reimbursement rate for CPT 73562 in 2025?
The 2025 Medicare national average reimbursement for CPT 73562 is $39.46 for both facility and non-facility settings. This rate is based on the total RVU of 1.22 multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustments in your area.
What is the difference between CPT 73560, 73562, and 73564?
CPT 73560 is a knee x-ray with 1-2 views, 73562 is a 3-view knee x-ray, and 73564 is a complete knee x-ray study (typically 4 or more views). The number of views obtained and documented determines which code to bill. You cannot bill multiple codes from this family for the same knee on the same date as they represent different levels of the same service.
Do I need a modifier when billing 73562 for both knees?
Yes, you should use either RT/LT modifiers (billing 73562-RT and 73562-LT as two separate line items) or modifier 50 (bilateral) depending on payer requirements. Most Medicare contractors prefer the RT/LT approach for diagnostic radiology. Failure to use appropriate modifiers may result in payment for only one knee.
How many RVUs is CPT code 73562 worth in 2025?
CPT 73562 has a total RVU value of 1.22 in 2025, consisting of 0.18 work RVU, 1.02 practice expense RVU, and 0.02 malpractice RVU. Both facility and non-facility PE RVUs are the same at 1.02 because this is a technical procedure with similar practice costs regardless of setting.
What diagnosis codes support medical necessity for CPT 73562?
Common supporting diagnoses include knee pain (M25.561/M25.562), traumatic arthropathy (M17.0-M17.9), knee sprain/strain (S83.4-S83.9), meniscus disorders (M23.x), post-traumatic evaluation (follow-up injuries), and effusion (M25.461/M25.462). Always verify your local Medicare LCD policy as coverage criteria vary by contractor. Routine screening without symptoms is typically not covered.
Can I bill 73562 with an office visit on the same day?
Yes, you can bill an E/M service (office visit) with 73562 on the same day if the E/M service is significant and separately identifiable from the decision to perform the x-ray. Append modifier 25 to the E/M code. The E/M should be supported by documentation beyond simply ordering the x-ray, such as history taking, examination, and medical decision-making regarding treatment options.
Should I use modifier 26 or TC when billing CPT 73562?
Use modifier 26 if you are only billing for the physician interpretation (professional component), typically done by the radiologist reading the films. Use modifier TC if billing only the technical component (equipment, technologist, supplies), typically done by the imaging facility. Bill the code without modifiers (global) only if your practice owns the equipment and provides both the technical service and professional interpretation.