Computed tomography of the thoracic spine done without contrast, mainly to evaluate fractures, bone detail, and hardware.
- Medicare
- $130.26
- Work RVU
- 0.98
- Global, days
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Trauma history, fracture suspicion, or surgical planning reason
- Results of prior thoracic plain films
- Neurologic exam findings
- Signed report with fracture description or hardware assessment
- Authorization for commercial payers
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
72128 is non-contrast CT of the thoracic spine. Spine surgeons order it for compression and burst fractures, to measure canal compromise, to plan pedicle screws in deformity cases, and to check fusion or screw position after surgery.
Osteoporotic compression fractures are a common driver. Before kyphoplasty or vertebroplasty, CT helps show posterior wall integrity and fracture pattern. Note that the augmentation codes include imaging guidance during the procedure, but a separate diagnostic CT done on a different day for workup is billable.
Watch the overlap with chest CT. If a patient had a chest CT the same day, a payer may question a separate thoracic spine CT unless the spine images were separately acquired or reconstructed and interpreted for a spine question. Commercial plans generally require prior authorization. Thoracic pain without trauma, neuro deficit, or red flags is a weak indication, and reviewers will ask for plain films first.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.98) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.9) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.98 |
| Practice expense RVU | 2.85 |
| Malpractice RVU | 0.07 |
| Total RVU | 3.9 |
| Medicare national rate | $130.26 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $130.26 |
HOPD (APC 5522) Hospital outpatient department | $106.81 |
Common denial reasons
The recurring reasons claims for CPT 72128 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Same-day chest CT without a distinct spine indication
- No prior authorization
- Nonspecific back pain diagnosis without red flags
- Billed as part of kyphoplasty when it was intraprocedural guidance
- Missing report for professional component
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Can I bill 72128 with a chest CT on the same day?
02Is CT thoracic spine billable before kyphoplasty?
03Is 72128 subject to the multiple procedure imaging reduction?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes spell out the fracture mechanism, pain level, and neuro findings that justify thoracic CT, so the medical necessity is in the visit note.
See how Mira captures CPT 72128 documentation