Pelvic MRI with a non-contrast image set followed by contrast-enhanced images, interpreted together in one session.
- Medicare
- $334.34
- Work RVU
- 2.15
- Global, days
- Region
- Hip
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Clinical concern: tumor staging, infection, or complex postoperative question
- Field of view covered
- Report describing both phases
- Gadolinium agent, dose, and renal screening
- Authorization matching 72197
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 ↓
72197 is pelvic MRI without and with contrast. For orthopedic oncology, it is the usual protocol for staging a pelvic bone or soft tissue tumor. It is also used for suspected osteomyelitis, septic sacroiliitis, and complex postoperative questions around the pelvis.
The pelvis versus hip distinction matters. One hip joint is coded with 73721 to 73723. When the radiologist images the whole pelvis, including both hips and the sacrum, use the pelvis codes. Some practices order a hip MRI and receive a pelvis study; the claim has to follow what was performed and what the authorization covered.
Do not bill 72195 and 72196 together for one session. Gadolinium goes on its own HCPCS line in the office. If the patient also gets lumbar MRI the same day, both are billable with separate reports, and the imaging multiple procedure reduction applies. Document renal screening when the patient has kidney disease or diabetes.
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 (2.15) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.01) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 2.15 |
| Practice expense RVU | 7.7 |
| Malpractice RVU | 0.16 |
| Total RVU | 10.01 |
| Medicare national rate | $334.34 |
| 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 | $334.34 |
HOPD (APC 5572) Hospital outpatient department | $356.43 |
Common denial reasons
The recurring reasons claims for CPT 72197 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- 72195 and 72196 billed together
- Ordered as hip MRI but billed as pelvis without updated authorization
- No indication for contrast
- Missing gadolinium line or wrong units
- Duplicate claim with lumbar MRI without separate report
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Can I bill 72195 and 72196 together?
02When should pelvic MRI be coded instead of hip MRI?
03Is pelvic MRI with contrast used for bone tumors?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records the mass, infection signs, or postoperative concern in the surgeon's words, which supports a with-and-without pelvic MRI.
See how Mira captures CPT 72197 documentation