Imaging · Other

MRI of the pelvis performed without contrast material, producing soft-tissue images of pelvic structures without intravenous dye administration.

Verified May 8, 2026 · 5 sources ↓

Medicare: $227.46
Total RVUs: 6.81
Global, days
Region: Other

Drawn from CMSMdclarityCgsmedicareMolinamarketplace

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 specific enough to justify non-contrast protocol (e.g., mass characterization, anatomy evaluation, post-op assessment) — 'pelvic pain' alone frequently triggers medical necessity denials.
Ordering provider name and NPI documented in the radiology order and report.
Radiologist's signed interpretation report with findings, impression, and date of service.
Prior authorization number on the claim when required by the payer — missing auth is one of the top denial drivers for pelvic MRI.
Contrast decision rationale: if ordering without contrast when payer LCD or guideline suggests with-contrast protocol, document clinical reasoning for the non-contrast approach.

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

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

72195 covers a non-contrast MRI of the pelvis. It is the baseline study in the 72195–72197 family: 72196 adds contrast only, and 72197 covers without-then-with contrast sequences. When clinical questions can be answered without gadolinium — screening for soft-tissue masses, evaluating pelvic floor anatomy, staging certain gynecologic or urologic pathology, or assessing post-operative changes — 72195 is the appropriate choice.

The global period is XXX, meaning no surgical global applies and each encounter bills independently. The technical and professional components split using modifiers TC and 26 respectively, which is the norm when the radiologist interpreting the study is employed or contracted separately from the facility performing it. Orthopedic surgeons ordering this study should confirm the clinical indication is documented in the order — payer prior-authorization requirements for pelvic MRI are common and denial on medical necessity grounds is a routine issue.

For Medicare, the Multiple Procedure Payment Reduction (MPPR) rule applies to the technical component when 72195 is billed same-day with another imaging study. The reduced TC RVU applies automatically; no modifier is needed to trigger the reduction, but billers should anticipate the lower payment and not appeal it as an error.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.42
Practice expense RVU	5.3
Malpractice RVU	0.09
Total RVU	6.81
Medicare national rate	$227.46
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	$227.46
HOPD (APC 5523) Hospital outpatient department	$243.77

Common denial reasons

The recurring reasons claims for CPT 72195 get rejected.

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

Missing or expired prior authorization — most commercial payers require PA for pelvic MRI regardless of ordering specialty.
Vague clinical indication on the order: 'pelvic pain' or 'r/o pathology' without a supporting ICD-10 code that maps to a covered indication.
MPPR-related underpayment misread as a denial when billing TC same-day with another imaging study — confirm payment matches expected reduced rate before appealing.
Component billing mismatch: billing the global (no modifier) when the interpreting radiologist and the facility are separate entities, or billing TC and 26 separately when they are the same entity.
Upcoding audit flag when 72197 (without and with contrast) is billed but only a non-contrast series was performed — ensure the code matches the actual protocol performed.

Frequently asked questions

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

01When should I bill 72195 versus 72197?

Bill 72195 when only non-contrast sequences were performed. Bill 72197 when the protocol includes both pre-contrast and post-contrast sequences in the same session. If gadolinium was administered, 72195 is wrong regardless of what was ordered — the code must reflect what was actually performed.

02How do I split the TC and 26 components?

Append modifier TC when billing for the technical component only (facility/equipment/technologist). Append modifier 26 when billing for the professional interpretation only. Bill without a modifier only when the same entity owns both components — uncommon in most hospital-based or IDTF settings.

03Does 72195 require prior authorization for Medicare?

Medicare does not require prior authorization for 72195 under most MACs, but medical necessity must still be supported by a covered ICD-10 diagnosis. Commercial payers and Medicaid managed care plans almost universally require PA — check payer-specific policies before scheduling.

04Can 72195 be billed same-day with a hip or lumbar spine MRI?

Yes, but the MPPR applies to the TC when multiple imaging studies are billed same-day for Medicare. The second study's TC is reimbursed at a reduced rate. Document distinct clinical indications for each study and use modifier 59 if NCCI edits flag the combination.

05What ICD-10 codes support medical necessity for non-contrast pelvic MRI in orthopedic practice?

Common covered diagnoses include sacral stress fractures (M84.352–M84.359), sacroiliac joint pathology (M46.1x), pelvic soft-tissue masses, avascular necrosis involving the femoral head when CT is inconclusive, and post-operative evaluation of pelvic hardware. Specificity matters — use the most granular code available.

06Is modifier 22 ever appropriate for 72195?

Rarely, but yes — if the study required substantially increased work due to patient body habitus, implants requiring additional sequences, or repeat acquisitions due to motion that extended radiologist interpretation time significantly, modifier 22 can be appended with documentation supporting the increased work. Expect scrutiny and a written explanation.

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 indication, contrast decision, and ordering context from the radiologist's or referring provider's dictation — locking in the specificity needed to match a covered ICD-10 code before the claim is submitted. That prevents the most common denial for 72195: a vague or absent indication that fails medical necessity review at prior authorization or at adjudication.

See how Mira captures CPT 72195 documentation