MRI of any upper extremity joint — shoulder, elbow, or wrist — performed without contrast material.

Verified May 8, 2026 · 6 sources ↓

Medicare: $205.08
Total RVUs: 6.14
Global, days
Region: Multi-region

Drawn from CMSIsmanetThe-rheumatologist

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact joint imaged (e.g., glenohumeral, radiocarpal, humeroulnar) — 'upper extremity joint' alone is insufficient.
Document laterality explicitly; LT or RT must be supported by the order and the report.
Confirm no contrast was administered; if contrast was used, 73221 is the wrong code.
Ordering provider's clinical indication must be present — required for AUC/CDSM consultation under CMS advanced diagnostic imaging policy.
For IDTF billing, document supervising physician credentials (board-certified radiologist or orthopedic surgeon) and technologist certification (ARRT-MR or ARMRIT).
Radiologist interpretation report must include comparison with prior studies where available and a formal written conclusion.

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 LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

73221 covers non-contrast MRI of any joint in the upper extremity. That includes the glenohumeral, acromioclavicular, and sternoclavicular joints at the shoulder; the humeroulnar, humeroradial, and proximal radioulnar joints at the elbow; and the radiocarpal, midcarpal, and distal radioulnar joints at the wrist. One code covers all of these — the joint imaged doesn't change the code, but it must be documented and identified with a laterality modifier.

When a facility owns the equipment and a radiologist interprets the study, the facility bills the global service. A hospital-based radiologist reading a study performed in the hospital department bills modifier 26 for the professional component only; the facility separately bills the technical component. IDTFs billing 73221 must have the study supervised by a board-certified radiologist or orthopedic surgeon and performed by an ARRT-MR or ARMRIT-certified technologist.

Never report 73221 and 73222 or 73223 for the same joint on the same date. RAC topic 0147 (Excessive Units) specifically targets this: when a more extensive MRI is performed at the same site, the less extensive code bundles into it. If both pre- and post-contrast sequences are acquired in a single session, bill 73223, not 73221 plus 73222. For non-joint upper extremity structures — humerus, forearm, hand — use 73218, not 73221.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.32
Practice expense RVU	4.73
Malpractice RVU	0.09
Total RVU	6.14
Medicare national rate	$205.08
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	$205.08
HOPD (APC 5523) Hospital outpatient department	$243.77

Common denial reasons

The recurring reasons claims for CPT 73221 get rejected.

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

Missing laterality modifier — billing 73221 without LT or RT triggers automatic rejection from most payers.
Unbundling with 73222 or 73223 for the same joint and date — RAC automated review flags this under topic 0147.
Wrong code family: using 73221 for non-joint upper extremity structures (humerus, forearm) instead of 73218.
Absent or inadequate AUC/CDSM documentation for Medicare outpatient advanced imaging orders.
IDTF claims denied for missing supervising physician or technologist credential documentation.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can I bill 73221 for a shoulder MRI that covers both the glenohumeral and acromioclavicular joints?

Yes. One 73221 covers the shoulder joint complex in a single session. You don't stack codes because multiple articulations within the same joint region were imaged. Document all joints evaluated in the report.

02The radiologist ordered gadolinium mid-study after reviewing the non-contrast sequences. Can I still bill 73221?

No. If contrast was administered during the session — even if added after non-contrast sequences — bill 73223 (without and with contrast), not 73221. Billing 73221 when contrast was given is a misrepresentation of the service and a RAC audit target.

03What's the difference between 73221 and 73218?

73221 is for joint structures — shoulder, elbow, wrist. 73218 is for non-joint upper extremity structures such as the humerus, forearm, or hand. The distinction is joint vs. non-joint, not upper vs. lower arm.

04Does a hospital-employed radiologist bill 73221 globally?

No. A hospital-employed radiologist interpreting studies performed in the hospital department bills 73221-26 for the professional component only. The hospital bills the technical component separately. Only freestanding imaging centers and IDTFs typically bill the global service.

05Is prior authorization required for 73221?

Prior auth requirements vary by payer and plan. Medicare requires AUC/CDSM consultation documentation for outpatient advanced imaging orders. Commercial payers vary widely — check each plan's policy. Missing prior auth is a top denial reason for elective joint MRIs.

06Can 73221 be billed bilaterally on the same date?

Yes, if both upper extremity joints are imaged on the same date, bill 73221-LT and 73221-RT as separate line items. Do not use modifier 50 for bilateral radiology services — report each side on its own line with the appropriate laterality modifier.

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 specific joint imaged (e.g., glenohumeral vs. radiocarpal), laterality, and explicit confirmation that no contrast was administered — directly from dictation. That prevents the two most common 73221 denials: missing LT/RT and incorrect contrast-level code selection that triggers RAC unbundling review.

See how Mira captures CPT 73221 documentation