Thoracic spine MRI performed first without contrast and then repeated after contrast during one imaging session.
- Medicare
- $318.64
- Work RVU
- 2.23
- 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 ↓
- Suspected diagnosis needing contrast (metastasis, infection, abscess)
- Relevant history: cancer, IV drug use, fever, lab values
- Report confirming both phases
- Gadolinium agent and dose
- Authorization for outpatient studies
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 ↓
72157 is thoracic spine MRI without and with contrast. In orthopedic and spine care it comes up for suspected metastatic disease, discitis or osteomyelitis, epidural abscess, and intradural lesions. Routine thoracic disc or degenerative questions are usually answered with non-contrast MRI (72146).
It is often part of a full-spine workup, such as a cancer patient with new back pain or a patient with sepsis and spine tenderness. In those cases the cervical and lumbar regions are billed with their own codes, and the technical component of the additional studies is reduced under the imaging multiple procedure rule.
Typical denials: billing 72146 and 72147 for one session instead of 72157, authorizations that list only the non-contrast code, and notes that never state the infection or cancer concern. Gadolinium is billed separately in the office with the HCPCS agent code. Inpatient and emergency studies bypass most authorization rules, but outpatient follow-ups do not.
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 (2.23) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.54) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 2.23 |
| Practice expense RVU | 7.15 |
| Malpractice RVU | 0.16 |
| Total RVU | 9.54 |
| Medicare national rate | $318.64 |
| 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 | $318.64 |
HOPD (APC 5572) Hospital outpatient department | $356.43 |
Common denial reasons
The recurring reasons claims for CPT 72157 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- 72146 and 72147 billed together
- Authorization for non-contrast study
- Indication is routine degenerative pain
- Gadolinium supply line missing or wrong units
- Duplicate billing across regions without separate reports
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Is 72157 the right code for thoracic MRI with and without contrast?
02What diagnoses support thoracic MRI with contrast?
03Is the multiple procedure reduction applied to full-spine MRI?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe captures the cancer history, fever, or lab findings that make contrast necessary, so the thoracic MRI order stands on the note.
See how Mira captures CPT 72157 documentation