Lumbar spine CT with an initial non-contrast scan followed by a post-contrast scan in the same session, read as one study.
- Medicare
- $196.73
- Work RVU
- 1.24
- 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 ↓
- Report showing both pre- and post-contrast series
- Clinical suspicion requiring contrast (infection, tumor)
- MRI contraindication if relevant
- Contrast agent and dose
- Authorization for the with-and-without code
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 ↓
72133 covers lumbar CT done without contrast and then with contrast. It is the single code for both phases. Billing 72131 and 72132 together for one session is a coding error.
Ortho practices rarely order it directly. It may be used for suspected discitis, epidural abscess, or tumor when MRI cannot be done, or when a radiology protocol calls for both phases. A plain CT myelogram is normally a single post-contrast scan and belongs under 72132, not 72133. Only use 72133 when the report clearly shows a non-contrast series before contrast.
Authorization is where these claims fall apart. A plan that approved 72131 or 72132 will deny 72133 unless the authorization is updated. The note should explain why contrast was needed and why MRI was not the choice. If the patient refused or could not tolerate contrast and only the first phase was done, bill 72131.
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 (1.24) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.89) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.24 |
| Practice expense RVU | 4.56 |
| Malpractice RVU | 0.09 |
| Total RVU | 5.89 |
| Medicare national rate | $196.73 |
| 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 | $196.73 |
HOPD (APC 5571) Hospital outpatient department | $179.20 |
Common denial reasons
The recurring reasons claims for CPT 72133 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- 72131 and 72132 billed together
- Authorization for a single-phase study
- Only one phase documented in the report
- CT myelogram coded as 72133 instead of 72132
- Weak indication for contrast
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Is a lumbar CT myelogram 72133?
02Can I bill 72131 and 72132 on the same day?
03What if contrast was planned but not given?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records the infection or tumor concern and any MRI contraindication, so the reason for a two-phase lumbar CT is documented in the visit.
See how Mira captures CPT 72133 documentation