CPT 73564Radiology

X-ray exam knee 4 or more

CPT code 73564 covers a comprehensive x-ray examination of the knee that includes four or more different views, providing detailed imaging from multiple angles to diagnose knee injuries or conditions.

Showing rates for

National Average

Base Medicare rate

$45.93

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

0.22

PE RVU (NF)

1.18

MP RVU

0.02

Total RVU

1.42

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

NCCI bundling edits

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Billing tips

Verify exact view count before billing - if only 3 views obtained, use 73562 instead to avoid downcoding
Impact: Prevents automatic downcoding from $45.93 to approximately $36 and reduces appeals workload
Document all four specific view types in the radiology report (AP, lateral, oblique, sunrise, etc.) to substantiate medical necessity
Impact: Reduces denial rate by 30-40% for insufficient documentation and supports medical necessity on audit
For bilateral knee studies, bill 73564-50 (bilateral modifier) rather than two separate line items unless payer specifically requires line-item billing
Impact: Streamlines processing and ensures 150% payment ($68.90 for both knees) rather than risking bilateral denial
Append RT/LT modifiers even when not explicitly required by Medicare as many commercial payers mandate laterality
Impact: Prevents 15-20% of claims from being returned or denied for missing information
When performed same day as E/M service, ensure distinct documentation that imaging was not part of routine visit decision-making
Impact: Supports separate reimbursement and prevents bundling denials worth $45.93 per study
Submit professional (26) and technical (TC) components separately when services are split-billed between facility and physician practice
Impact: Ensures proper payment distribution and prevents claim rejections for duplicate billing

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 73564 in 2025?

The 2025 Medicare national average payment for CPT 73564 is $45.93 for both facility and non-facility settings. This rate is based on 1.42 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality adjustment.

What is the difference between CPT 73562 and 73564?

CPT 73562 covers knee x-rays with 3 views, while 73564 requires 4 or more views. The key distinction is the number of separate radiographic projections obtained. Code selection must accurately reflect the views documented in the imaging report to avoid downcoding or compliance issues.

How do you bill for bilateral knee x-rays with 4 views?

For bilateral knee x-rays, bill CPT 73564 with modifier 50 (bilateral procedure) for most payers, which typically reimburses at 150% of the single procedure rate ($68.90 for Medicare). Some payers require two separate line items with RT and LT modifiers instead. Verify payer-specific bilateral billing requirements before submitting.

What RVU value is assigned to CPT 73564 in 2025?

CPT 73564 has a total RVU of 1.42 for 2025, consisting of 0.22 work RVU, 1.18 practice expense RVU (both facility and non-facility), and 0.02 malpractice RVU. These values are from the CMS Physician Fee Schedule released December 23, 2024.

Can CPT 73564 be billed with an office visit on the same day?

Yes, CPT 73564 can be billed with an E/M service on the same day when both are medically necessary and separately documented. The imaging must be ordered based on findings from the examination and should not be considered a routine part of the visit. No modifier is typically required on the radiology code, but documentation must clearly support separate services.

What documentation is required to bill CPT 73564?

Documentation must include a formal radiology report identifying at least four specific radiographic views (e.g., AP, lateral, oblique, sunrise), laterality specification, clinical indication, and a signed physician interpretation with findings and impression. The technologist's imaging protocol and technical factors should also be available to support the service performed.

Does CPT 73564 require prior authorization from insurance?

Prior authorization requirements vary by payer and plan. While Medicare typically does not require prior authorization for 73564, many commercial payers and Medicare Advantage plans do require authorization for outpatient imaging. Always verify authorization requirements with the specific payer before performing the study to avoid denial.