Imaging · Spine

MRI of the lumbar spinal canal and its contents performed first without contrast, then repeated after contrast administration for enhanced visualization.

Verified May 8, 2026 · 5 sources ↓

Medicare: $318.31
Total RVUs: 9.53
Global, days
Region: Spine

Drawn from CMSAAPCMolinamarketplace

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Clinical indication specifying why contrast is medically necessary, not just why lumbar MRI is ordered
Documentation of prior conservative treatment or failed non-contrast imaging when required by payer policy
Radiology report confirming two-phase acquisition: pre-contrast sequences and post-contrast sequences with gadolinium
Ordering provider's documented clinical findings or diagnosis supporting the specific ICD-10 codes submitted with the claim
Contrast agent administered, dose, and route documented in the procedure or radiology report
For IDTF billing: radiologist supervision documented and MR technologist credentials on file

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

26 Professional component 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

72158 is the correct code when a lumbar spine MRI is performed as a two-phase study: non-contrast sequences first, followed by gadolinium injection and additional contrast-enhanced sequences. It is not interchangeable with 72148 (without contrast only) or 72149 (with contrast only). If a radiologist reads 72148 and 72149 billed from separate same-day encounters, payers will typically bundle them and expect 72158 instead.

Contrast-enhanced lumbar MRI is clinically indicated when post-surgical evaluation is needed (distinguishing recurrent disc herniation from epidural fibrosis), when infection, tumor, or vascular pathology is suspected, or when myelopathy findings require more detail than non-contrast sequences provide. Payers applying the CMS LCD for lumbar MRI (A57207) require the ordering diagnosis to support medical necessity for contrast specifically — not just for lumbar spine imaging in general.

At IDTFs, CMS requires a radiologist for physician supervision and an ARRT-credentialed MR technologist (R.T.-MR or ARMRIT-RT-MR) for technical performance. Modifier 26 isolates the professional component when the radiologist bills interpretation separately from a facility technical bill. Billing the global service from a non-facility setting requires both components to be performed and documented by the same group.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.23
Practice expense RVU	7.14
Malpractice RVU	0.16
Total RVU	9.53
Medicare national rate	$318.31
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	$318.31
HOPD (APC 5572) Hospital outpatient department	$356.43

Common denial reasons

The recurring reasons claims for CPT 72158 get rejected.

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

Medical necessity denied because the submitted ICD-10 code supports non-contrast imaging only, not the with-and-without contrast study
Duplicate claim denial when 72148 and 72149 are billed separately for a single same-day two-phase study instead of 72158
Missing prior authorization for contrast-enhanced MRI, which many commercial payers require separately from non-contrast lumbar MRI
Radiology report does not confirm both pre-contrast and post-contrast sequences were performed, making the upgrade to 72158 unsupported
IDTF claim denied for failure to meet physician supervision or technologist credential requirements per CMS Article A54953

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can I bill 72148 and 72149 together when a lumbar MRI is done with and without contrast on the same day?

No. When both phases are performed in a single session, 72158 is the correct code. Billing 72148 and 72149 separately for a single two-phase study will typically result in a bundling edit or duplicate claim denial.

02What modifier do I use when billing only the radiologist's interpretation of a 72158?

Use modifier 26 to isolate the professional component. The facility or IDTF bills the technical component separately without a modifier (or with TC if the payer requires it).

03Which ICD-10 codes support medical necessity for 72158 specifically versus 72148?

CMS LCD A57207 includes diagnoses like post-fusion status (M43.26–M43.27), spondylosis with myelopathy or radiculopathy (M47.16, M47.26–M47.28), and other conditions where contrast adds diagnostic value. Simple mechanical low back pain codes typically support only non-contrast imaging.

04Does 72158 require prior authorization?

Most commercial payers require prior authorization for contrast-enhanced spine MRI. Authorization obtained for a non-contrast lumbar MRI does not automatically cover 72158 — verify the auth explicitly covers the with-and-without contrast study before scheduling.

05What are the technologist credential requirements for billing 72158 from an IDTF?

Per CMS Article A54953, the MR technologist must hold ARRT R.T.-MR or ARMRIT-RT-MR credentials. A general radiology technologist credential does not satisfy this requirement for MRI studies.

06Is modifier 59 ever appropriate with 72158?

Rarely. Modifier 59 could apply if a distinct, separately identifiable spine MRI study at a different level is performed and documented at the same session, but this scenario is uncommon. Don't use 59 simply because two MRI codes appear on the same claim.

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 clinical rationale for contrast from dictation — post-surgical evaluation, suspected infection, tumor, or vascular lesion — and flags when only a generic 'low back pain' indication is documented. That prevents the most common 72158 denial: a diagnosis that supports 72148 but not the contrast-enhanced study. The scribe also tags two-phase acquisition confirmation so the radiology report language aligns with the billed code.

See how Mira captures CPT 72158 documentation