CPT 74712Radiology

Mri fetal sngl/1st gestation

CPT 74712 covers an MRI scan of a fetus during pregnancy, specifically for the first baby in a single or multiple pregnancy. This advanced imaging helps doctors evaluate fetal development and diagnose potential complications without using radiation.

Showing rates for

National Average

Base Medicare rate

$402.07

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

PE RVU (NF)

9.24

MP RVU

0.19

Total RVU

12.43

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

NCCI bundling edits

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Billing tips

Document specific ultrasound findings that necessitate MRI escalation in the ordering physician's notes and include this information in the radiology report
Impact: Reduces medical necessity denials by up to 60% and establishes clear justification for the $402.07 reimbursement
Bill 74713 separately for each additional fetus beyond the first in multiple gestation pregnancies to capture full reimbursement
Impact: Prevents revenue loss of $402.07 per additional fetus in twins, triplets, or higher-order multiples
Verify that gestational age is clearly documented (typically 18-36 weeks); fetal MRI before 18 weeks or after delivery faces high denial rates
Impact: Prevents approximately 30% of pre-authorization and post-payment denials
Code contrast administration separately with 96374 only if gadolinium is used (rare in fetal MRI); most fetal MRIs are non-contrast studies
Impact: Avoid upcoding allegations while capturing legitimate additional reimbursement when contrast is medically necessary and documented
Ensure diagnosis codes specify suspected fetal condition (O35.xx series) rather than maternal symptoms alone to support medical necessity
Impact: Increases first-pass approval rate by 40-50% and strengthens appeal position if denied
Submit claims within 30 days of service and include comparative ultrasound report or reference in MRI report documentation
Impact: Accelerates payment cycle and reduces requests for additional information that delay the $402.07 payment

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Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT 74712?

The 2025 Medicare national average payment for CPT 74712 is $402.07 for both facility and non-facility settings. This rate is based on 12.43 total RVUs (3.0 work RVU, 9.24 practice expense RVU, 0.19 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Does CPT 74712 require prior authorization from Medicare or commercial payers?

Most commercial payers require prior authorization for CPT 74712 due to its advanced imaging classification and high reimbursement rate. Medicare typically does not require prior authorization but may subject claims to medical necessity review. Always verify payer-specific requirements before scheduling to avoid denials.

What is the difference between CPT 74712 and 74713?

CPT 74712 covers MRI of a single fetus or the first fetus in a multiple gestation pregnancy. CPT 74713 is an add-on code used for each additional fetus beyond the first in multiple gestations (twins, triplets, etc.). Code 74713 must be billed with 74712 and cannot be reported alone.

Can I bill CPT 74712 and a pelvic ultrasound on the same day?

Yes, fetal MRI (74712) and obstetric ultrasound can be billed on the same day as they provide complementary diagnostic information. However, documentation must clearly justify the medical necessity of both procedures and explain what specific clinical questions each modality addresses. Modifier 59 may be required to prevent bundling.

What diagnosis codes support medical necessity for CPT 74712?

Common supporting ICD-10 codes include O35.xx series (maternal care for suspected fetal abnormality), O36.xx codes (maternal care for fetal problems), Q00-Q99 codes when specific fetal anomaly is suspected, and O41.xx codes for amniotic fluid disorders. The diagnosis must reflect a specific clinical indication beyond routine prenatal screening.

Is contrast material typically used with CPT 74712 fetal MRI?

No, gadolinium-based contrast is rarely used in fetal MRI due to concerns about fetal exposure and lack of established safety data in pregnancy. CPT 74712 describes a non-contrast examination. If contrast is exceptionally used and documented as medically necessary, it would be coded separately, but this is highly unusual in fetal imaging.

What are the work RVUs for CPT code 74712 in 2025?

CPT 74712 has 3.0 work RVUs, 9.24 practice expense RVUs (non-facility), 9.24 practice expense RVUs (facility), and 0.19 malpractice RVUs, totaling 12.43 RVUs. The work RVU reflects the physician time, skill, and intensity required to interpret the complex fetal MRI study and prepare a comprehensive diagnostic report.