Lumbar spine MRI performed only with contrast, without a separate set of non-contrast images during the same exam.
- Medicare
- $269.55
- Work RVU
- 1.74
- 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 ↓
- Reason for contrast (prior surgery, infection, tumor)
- Report confirming only post-contrast sequences
- Gadolinium agent, dose, and renal screening
- Prior surgery history and levels
- Authorization for 72149
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 ↓
72149 is lumbar MRI with contrast only. It is uncommon because the standard contrast protocol is without-then-with (72158). If the report describes T1 and T2 images before gadolinium and enhanced images after, the claim belongs under 72158.
In spine practice, contrast is added mainly after prior lumbar surgery to tell recurrent disc from scar, or when infection or tumor is in question. A truly post-contrast-only study usually means a non-contrast MRI was done recently and the radiologist is adding enhanced images to answer a follow-up question.
The rest is standard advanced imaging hygiene. The authorization must match the code. The record should show conservative care or a reason to skip it. Gadolinium goes on its own line with the HCPCS agent code and the correct unit count. Renal screening should be documented when risk factors exist. Coding 72149 when both phases were done undercodes the study and leaves the claim out of step with the report.
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 (1.74) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (8.07) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.74 |
| Practice expense RVU | 6.21 |
| Malpractice RVU | 0.12 |
| Total RVU | 8.07 |
| Medicare national rate | $269.55 |
| 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 | $269.55 |
HOPD (APC 5572) Hospital outpatient department | $356.43 |
Common denial reasons
The recurring reasons claims for CPT 72149 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Code does not match the sequences in the report
- Authorization covers non-contrast or with-and-without MRI
- No documented reason for contrast
- Contrast supply billed with wrong units
- Lumbar imaging without conservative care history
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01When is 72149 used instead of 72158?
02Why add contrast to a lumbar MRI after surgery?
03Do I bill gadolinium with 72149?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe documents prior surgery levels and why the surgeon needs scar versus disc distinguished, which supports contrast on a lumbar MRI.
See how Mira captures CPT 72149 documentation