what is the cpt code for mri lumbar spine w/o contrast for medicare

Non-traumatic lower back pain with failure of documented conservative care and without previous surgery, suspected infection or cancer Patient has experienced trauma or is osteoporotic with a suspected fracture Severe or progressive neurologic deficit and one or more red flags Depending on the clinical circumstances, an MRI Lumbar Spine Without Contrast (CPT® 72148) or an MRI Lumbar Spine Without and With Contrast (CPT® 72158) may be indicated Usually MRI Lumbar Spine Without contrast (CPT® 72148) First order an X-ray and, depending on the clinical circumstances and findings, an MRI Lumbar Spine Without Contrast (CPT® 72148) or CT Lumbar Spine Without Contrast (CPT® 72131) may be indicated

Full Answer

What is the average cost of a lumbar spine MRI?

The costs of a lumbar MRI will depend on the hospital/facility, geographical location, if the contrast is needed and if insurance is included. On average, a lumbar spine MRI is going to cost $500 to $3,000+ without insurance. However, if you have a health insurance policy, it should be covered.

How to interpret your lumbar MRI results?

• Sagittal: Often the easiest for non-doctors to interpret. Sagittal MRIs are basically side or profile views of your body. ...
• Coronal: These images are basically a "head on" view of your body. ...
• Cross-sectional: Often the hardest for non-doctors to interpret. ...

How to read a MRI of the normal lumbar spine?

Understanding Your MRI of the Lumbar Spine

• Normal Anatomy of the Lumbar Spine. ...
• Problems in the Lumbar Spine. ...
• Lumbar Spondylosis. ...
• Disc Desiccation. ...
• Disc Bulge/ Disc Protrusion/ Disc Extrusion/ etc…. ...
• Normal Disc Bulge Protrusion Extrusion
• Osteophytes. ...
• Ligamentum Hypertrophy. ...
• Facet Hypertrophy. ...
• Spondylolisthesis/ Subluxation. ...

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What is the CPT code for a lumbar MRI?

Lumbar Spine 72148 - w/o contrast 72149 - w/contrast 72158 - w/o & w/contrast Other MR Studies (MRI Sacrum & Coccyx charge as MRI Pelvis): 75557 - Cardiac MRI for morphology and function w/o contrast 75559 - w/stress imaging 75561 - Cardiac MRI for morphology and function w/ and w/o contrast and further seques 75563 - w/stress imaging

What is procedure code 73721?

CPT® Code 73721 in section: Magnetic resonance (eg, proton) imaging, any joint of lower extremity.

Does Medicare pay for CPT 76376?

Medicare would expect the base imaging procedure to be billed on the same claim as CPT code 76376 or 76377 the majority of the time. CPT codes 76376 and 76377 are allowed only when billed in conjunction with another computed tomography, magnetic resonance imaging or other tomographic modality procedure codes.

What is the CPT code 72146?

CPT® Code 72146 in section: Magnetic resonance (eg, proton) imaging, spinal canal and contents.

What is procedure code 70540?

CPT® Code 70540 in section: Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck.

Is CPT 93356 covered by Medicare?

New strain code is first echo technology to get Medicare reimbursement. As of January 1 2020, cardiologists in the United States can now report and bill for myocardial strain imaging using the new Category 1 CPT code +93356.

What is the CPT code 76376?

Diagnostic imaging Current Procedural Terminology (CPT) code 76376 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound) has been opened for provider type 20 (Physician, M.D., Osteopath, D.O) to bill with dates of service on or after February 1, 2019.

What does MRI w wo contrast mean?

MRI without contrast is the usual MRI procedure which is done without the use of the contrast agent. The results of the MRI procedure are as valuable and relevant as those done with the use of a contrast agent.

What are the MRI CPT codes?

MRI procedure codes (70549, 70553, 70559, 71552, 72197, 73220, 73223, 73720, 73723, and 74183) include a MRI sequence performed without contrast media, followed by a MRI sequence performed with contrast media, and followed by MRI further sequences. The contrast medium used may be billed separately.

What is the description of CPT code 73221?

CPT® Code 73221 in section: Magnetic resonance (eg, proton) imaging, any joint of upper extremity.

What is procedure code 74183?

CPT® Code 74183 in section: Magnetic resonance (eg, proton) imaging, abdomen.

What is the CPT code 72141?

CPT® Code 72141 in section: Magnetic resonance (eg, proton) imaging, spinal canal and contents.

What is the CPT code 70553?

CPT® Code 70553 in section: Magnetic resonance (eg, proton) imaging, brain (including brain stem)

What is spine evaluation?

Evaluation of the spine in patients with infections of the brain, spinal column or contiguous areas or those having systemic infection. Detection and characterization of neoplastic processes that may affect the spine, either primary or secondary.

When is imaging appropriate?

Imaging is generally appropriate in the absence of reliable history and/or physical information, or when examination cannot exclude the possibility of significant injury of the spine or spinal contents. For assessment of prolonged pain, pain with neurological manifestations or with an unusual presentation of pain.

Is MRI covered by CMS?

Nationally Non-Covered Indications: CMS has determined that MRI of cortical bone and calcifications, and procedures involving spatial resolution of bone and calcifications, are not considered reasonable and necessary indications within the meaning of section 1862 (a) (1) (A) of the Act, and are therefore non-covered.

Does MRI use ionizing radiation?

Unlike computed tomography (CT) scanning, MRI does not make use of ionizing radiation or require iodinated contrast material (known for causing hypersensitivity reactions and nephrotoxicity in susceptible patients) to distinguish normal from pathologic tissue.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA), §1862 (a) (1) (A) states that no Medicare payment shall be made for items or services that "are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." Title XVIII of the Social Security Act, §1862 (a) (7) and 42 Code of Federal Regulations (CFR), §411.15 particular services excluded from coverage. Title XVIII of the Social Security Act, §1833 (e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim. Title XVIII of the Social Security Act, §1842 (p) (1)states that each claim submitted by a physician or practitioner shall include the appropriate diagnosis code (or codes)...".

Article Guidance

The following coding and billing guidance is to be used with its associated Local coverage determination.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.