CPT 73565Radiology

X-ray exam of knees

CPT code 73565 covers x-ray imaging of both knees during the same visit. This diagnostic imaging helps doctors evaluate knee pain, injuries, arthritis, or abnormalities in both knee joints simultaneously.

Showing rates for

National Average

Base Medicare rate

$38.82

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)

1.02

MP RVU

0.02

Total RVU

1.2

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

NCCI bundling edits

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Billing tips

Use 73565 only when both knees are imaged during the same session; do not append modifier 50 to this code as it already represents bilateral imaging
Impact: Prevents automatic denials and processing delays; incorrect use of modifier 50 with 73565 triggers bundling edits
If only one knee is imaged, bill 73560 (unilateral) with RT or LT modifier instead of 73565
Impact: 73560 reimburses at approximately 50% of bilateral rate; incorrect code selection may result in overpayment recovery
When splitting professional and technical components, ensure both parties use appropriate modifiers (26 or TC) to avoid duplicate payment issues
Impact: Prevents coordination of benefits denials and ensures correct payment distribution between facility and interpreting physician
Document medical necessity for bilateral imaging when only one knee has symptoms; note comparison views or suspected bilateral pathology
Impact: Reduces audit risk and denial rate; unilateral symptom presentation requires clear clinical rationale for bilateral study
Verify the number of views documented matches standard bilateral protocol (typically 6-8 total views for both knees); insufficient views may warrant 73562 instead
Impact: CPT 73562 (limited views) reimburses at lower rate; proper code selection based on views prevents downcoding
Check payer-specific guidelines for standing/weight-bearing views requirements, as some payers consider these separately reportable under certain conditions
Impact: Some commercial payers allow additional reimbursement for special weight-bearing bilateral views with appropriate documentation

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Frequently asked questions

What is the difference between CPT 73565 and 73560?

CPT 73565 is for bilateral knee x-rays (both knees), while 73560 is for a unilateral knee x-ray (one knee). Use 73565 when imaging both knees in the same session. The 2025 Medicare rate for 73565 is $38.82, while 73560 reimburses at approximately half that amount for single knee imaging.

Can I bill CPT 73565 with modifier 50 for bilateral knees?

No, do not use modifier 50 with CPT 73565. This code already represents bilateral imaging of both knees. Adding modifier 50 will result in claim denials or incorrect payment. The code descriptor specifically indicates it is for examination of both knees.

How much does Medicare pay for CPT 73565 in 2025?

The 2025 Medicare national average reimbursement for CPT 73565 is $38.82 for both facility and non-facility settings. This is based on 1.2 total RVUs (0.16 work RVU, 1.02 PE RVU, 0.02 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

When should I use CPT 73562 versus 73565 for knee x-rays?

Use CPT 73562 when obtaining limited views of bilateral knees (fewer than 3 views per knee). Use CPT 73565 for complete bilateral knee x-ray examination with minimum 3 views per knee. The number of views documented in the radiology report determines the appropriate code selection.

Do I need to document why both knees are being x-rayed if the patient only has pain in one knee?

Yes, when clinical presentation is unilateral but bilateral imaging is performed, document the medical necessity for imaging both knees. Common reasons include comparison views, suspected bilateral arthritis, previous bilateral pathology, or preoperative planning. This documentation prevents medical necessity denials.

Can CPT 73565 be billed with an office visit on the same day?

Yes, CPT 73565 can be billed with an E/M service on the same day when separately identifiable and documented. If the visit's primary purpose was to perform the x-ray without significant separate evaluation, only the x-ray may be billable. Use modifier 25 on the E/M code when significant, separately identifiable service is provided.

What modifiers are needed when billing the professional component only for CPT 73565?

Use modifier 26 when billing only the professional component (interpretation and report) of CPT 73565. This is common when a radiologist interprets images taken at a separate facility. The facility bills the technical component using modifier TC. Never bill the global code and component codes together.