CPT 76017Radiology

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CPT 76017 covers the work of a medical physicist who reviews and customizes MRI safety protocols for a specific patient, ensuring the magnetic field won't harm implanted devices or other patient-specific conditions.

Showing rates for

National Average

Base Medicare rate

$219.63

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

0.76

PE RVU (NF)

5.92

MP RVU

0.11

Total RVU

6.79

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

NCCI bundling edits

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Billing tips

Document physicist credentials prominently including board certification number and date of certification in medical record
Impact: Prevents 15-20% of denials related to qualified personnel requirements; ensures full $219.63 reimbursement
Clearly document customization details specific to patient implant manufacturer, model number, MRI field strength, and SAR limits established
Impact: Required for payment; generic safety checklists result in 40-60% denial rate versus customized protocols
Bill on separate claim line or different date than the actual MRI procedure when possible to avoid bundling edits
Impact: Increases clean claim rate by 25-30%; some payers automatically bundle when billed same day as 70000-79999 codes
Obtain prior authorization when required by commercial payers; Medicare does not require PA but many MACs audit this code heavily
Impact: Commercial payers deny 35-45% of claims without PA; Medicare post-payment audits affect approximately 12% of claims annually
Use time-based documentation showing physicist spent minimum 15-20 minutes on patient-specific evaluation to support RVU value of 6.79
Impact: Time documentation supports medical necessity during audits; codes with <10 minute documentation face 50% higher recoupment risk
Link service to specific MRI order with diagnosis codes supporting medical necessity for specialized safety evaluation
Impact: Medical necessity denials drop from 28% to under 5% when physicist evaluation is directly referenced in ordering physician documentation

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Frequently asked questions

What is CPT code 76017 used for?

CPT 76017 is used to bill for a medical physicist's customized MR safety examination for a specific patient, typically when the patient has implanted devices or conditions requiring individualized safety protocol development before MRI scanning.

How much does Medicare pay for CPT 76017 in 2025?

Medicare pays $219.63 for CPT 76017 in 2025 based on the national average rate. Both facility and non-facility rates are identical at $219.63, with a total RVU value of 6.79.

Who can bill CPT code 76017?

CPT 76017 must be billed for services performed by or under the direct supervision of a board-certified medical physicist (ABR, ABMP, or CCPM). The physicist must personally perform the patient-specific safety evaluation and protocol customization.

Can CPT 76017 be billed with an MRI procedure code?

Yes, but documentation must clearly show the physicist evaluation is a separate, customized service beyond standard MRI safety screening. Using modifier 59 or XU may be necessary to prevent bundling denials, and billing on separate dates can improve claim acceptance.

What documentation is required to bill CPT 76017?

Required documentation includes physicist credentials, patient-specific implant details with manufacturer/model information, customized safety protocol with specific SAR limits, risk assessment unique to the patient, and the physicist's signed report with date and time of evaluation.

Is prior authorization required for CPT 76017?

Medicare does not require prior authorization for 76017, but many commercial payers do require PA. Check payer-specific policies as 35-45% of commercial claims are denied without proper authorization.

What are common denial reasons for CPT 76017?

Common denials include lack of qualified physicist credentials, insufficient customization documentation showing only generic checklists, bundling with the MRI procedure, and failure to establish medical necessity for physicist-level evaluation versus standard screening.