CPT 73722Radiology

Mri joint of lwr extr w/dye

CPT 73722 covers an MRI scan of a lower extremity joint (knee, ankle, hip) performed with contrast dye injection to enhance image clarity and diagnostic accuracy.

Showing rates for

National Average

Base Medicare rate

$307.29

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

1.62

PE RVU (NF)

7.78

MP RVU

0.1

Total RVU

9.5

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

NCCI bundling edits

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Billing tips

Always verify prior authorization before scheduling - most payers require pre-certification for contrast MRI studies
Impact: Prevents 100% denial ($307.29 loss per claim) due to lack of authorization
Document specific joint imaged (knee, ankle, hip, foot) in operative note and claim - unspecified joint location triggers denials
Impact: Reduces denial rate by 25-30% and eliminates appeal costs averaging $45-60 per claim
Bill modifier 26 or TC appropriately based on ownership - never bill global code if you don't own both components
Impact: Prevents overpayment recoupment audits that can result in return of 50-60% of payments received
Use RT/LT modifiers consistently even when only one side is performed to meet NCCI and payer-specific requirements
Impact: Prevents 15-20% of claims from being placed on hold for clarification, improving cash flow by 7-10 days
Submit contrast type and dosage documentation with claim when billing high-value commercial payers
Impact: Reduces medical necessity denials by 18-22% for commercial payers with enhanced review protocols
For intra-articular contrast (MR arthrography), ensure injection procedure is separately documented and may be separately billable with appropriate arthrocentesis code
Impact: Captures additional $50-150 in reimbursement for injection procedure when performed by same provider

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 73722 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 73722 is $307.29 for both facility and non-facility settings. This rate is based on 9.5 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 73721 and 73722?

CPT 73721 is an MRI of a lower extremity joint without contrast material, while CPT 73722 is performed with contrast dye (typically gadolinium). The contrast-enhanced study (73722) provides superior visualization of soft tissues, cartilage, and vascular structures and reimburses at a higher rate. These codes cannot typically be billed together for the same joint on the same date.

Does CPT 73722 require prior authorization?

Yes, most Medicare Advantage plans and commercial insurance payers require prior authorization for CPT 73722. Original Medicare typically does not require prior authorization but does require medical necessity documentation. Performing the procedure without obtaining required authorization will result in claim denial and the provider may not be able to collect payment from the patient.

Can you bill CPT 73722 bilaterally with modifier 50?

Yes, modifier 50 can be used when MRI with contrast is performed on bilateral lower extremity joints (both knees, both ankles, etc.) during the same session. However, payer policies vary - some require two line items with RT/LT modifiers instead of modifier 50. Medicare typically reimburses bilateral procedures at 150% of the single procedure rate, which would be approximately $460.94.

What are the RVU values for CPT code 73722?

CPT 73722 has a work RVU of 1.62, non-facility practice expense RVU of 7.78, facility practice expense RVU of 7.78, and malpractice RVU of 0.10, for a total of 9.5 RVUs. These values are from the CMS 2025 Medicare Physician Fee Schedule released in December 2024.

What modifiers are most commonly used with CPT 73722?

The most common modifiers for CPT 73722 are 26 (professional component only), TC (technical component only), RT (right side), LT (left side), and 50 (bilateral procedure). Modifier 26 or TC splits the service when the interpreting physician and imaging facility are separate entities. RT/LT modifiers specify which joint was imaged and are required by most payers.

What documentation is required to bill CPT 73722?

Required documentation includes: medical necessity justification with specific clinical indication, identification of the specific joint and laterality, type and dosage of contrast agent used, route of administration, patient screening for contraindications, radiologist interpretation report describing contrast-enhanced sequences, and image acquisition parameters. Lack of documentation that contrast was actually administered is the most common reason for downcoding to 73721.