Imaging · Spine

MRI of the thoracic spinal canal and its contents performed without contrast material.

Verified May 8, 2026 · 6 sources ↓

Medicare: $190.39
Total RVUs: 5.7
Global, days
Region: Spine

Drawn from CMSAAPCCuresmbMdclarityEohhs

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Clinical indication specifying thoracic spine symptoms (e.g., mid-back pain, myelopathy, radiculopathy, suspected cord compression)
Explicit confirmation that no contrast material was administered
Ordering provider's documented medical necessity supporting non-contrast thoracic MRI over alternative imaging
Radiologist's signed interpretation report identifying the thoracic region (T1–T12) and all findings
Prior authorization number when required by the payer, noted in the billing record
Documentation distinguishing thoracic pathology from cervical or lumbar findings when multi-level symptoms are present

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 26 Professional component 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

72146 covers a non-contrast MRI of the thoracic spine — the mid-back segment from T1 through T12. It images the spinal canal, cord, intervertebral discs, and surrounding soft tissue without gadolinium or any other contrast agent. Common clinical indications include thoracic myelopathy, suspected disc herniation, vertebral fracture, tumor, or demyelinating disease affecting the thoracic cord.

This code has a global period of XXX, meaning it carries no surgical global package — each interpretation stands alone. When the professional and technical components are split between a radiologist and a freestanding imaging center, modifier 26 (professional read only) or TC (technical component only) must be appended. If both components are billed by the same entity, no modifier is needed. Prior authorization is required by many commercial payers; confirm before scheduling.

Do not confuse 72146 with 72148 (lumbar spine without contrast) or 72147 (thoracic spine with contrast). Upcoding to 72157 (thoracic with and without contrast) when only a non-contrast study was performed is an audit trigger. If a contrast run is added after the non-contrast series, bill 72157 instead of stacking 72146 and 72147.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.44
Practice expense RVU	4.16
Malpractice RVU	0.1
Total RVU	5.7
Medicare national rate	$190.39
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	$190.39
HOPD (APC 5523) Hospital outpatient department	$243.77

Common denial reasons

The recurring reasons claims for CPT 72146 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Wrong region coded — 72146 billed when the scan was cervical (72141) or lumbar (72148)
Contrast administered but non-contrast code submitted — should be 72147 or 72157
Missing or insufficient medical necessity documentation; generic 'back pain' without clinical detail
Prior authorization absent or expired at time of service
Professional component billed without modifier 26 when the technical component was performed at a separate facility
Duplicate claim when 72146 and 72147 are stacked on the same date instead of billing the combined 72157

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between 72146 and 72148?

72146 is thoracic spine MRI without contrast (T1–T12). 72148 is lumbar spine MRI without contrast (L1–S1). Billing 72146 for a lumbar study is a coding error and a common denial trigger.

02When should I bill 72157 instead of 72146?

Bill 72157 when both non-contrast and contrast series of the thoracic spine are performed in the same session. Do not stack 72146 plus 72147 — that combination is incorrect coding and will be bundled or denied.

03How do I split-bill when the radiologist reads a scan performed at a separate imaging center?

The radiologist bills 72146-26 for the professional read. The imaging center bills 72146-TC for the technical component. Neither entity bills the global without a modifier in a split arrangement.

04Does 72146 require prior authorization?

Medicare does not require prior auth for 72146, but many commercial and managed care payers do. Confirm payer-specific requirements before the scan — retro-auth denials are rarely reversible.

05Can 72146 be billed on the same day as a cervical or lumbar MRI?

Yes. Thoracic (72146), cervical (72141), and lumbar (72148) MRIs are distinct anatomic regions and can be billed together when medically necessary. Each requires its own documented clinical indication. Append modifier 59 or XS if the payer's edit logic bundles them.

06Is modifier 22 ever appropriate for 72146?

Rarely, but it applies when the imaging encounter requires substantially greater work than typical — for example, a patient with severe scoliosis or metallic implants requiring extended acquisition sequences and a more complex interpretation. Documentation must quantify the added complexity.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the thoracic spine level explicitly (T1–T12), confirms absence of contrast administration, and logs the clinical indication (myelopathy, cord compression, disc disease, trauma) directly from dictation. That prevents the most common denial for 72146: a generic or region-mismatched indication that triggers a medical necessity rejection or a wrong-code edit flagging lumbar versus thoracic.

See how Mira captures CPT 72146 documentation