Imaging · Shoulder

MRI of an upper extremity joint performed with contrast material — covers shoulder, elbow, wrist, or hand joints.

Verified May 8, 2026 · 5 sources ↓

Medicare: $312.63
Total RVUs: 9.36
Global, days
Region: Shoulder

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which joint was imaged — shoulder, elbow, wrist, or hand joint — not just 'upper extremity'.
Confirm contrast was administered and document the type and route of contrast material.
Include laterality in the order, report, and claim — use LT or RT modifier as appropriate.
Document the clinical indication driving the contrast study (e.g., suspected labral tear, ligamentous injury, osteochondral defect).
If arthrogram injection preceded the MRI, the injection note and guidance documentation must be separate from the MRI report.
Radiologist or interpreting physician must sign and date the formal written report for Medicare compliance.

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 LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

73222 is the go-to code when MRI of an upper extremity joint is performed with contrast. It applies to any joint in the upper extremity — shoulder, elbow, wrist, or the joints of the hand. If no contrast is used, bill 73221 instead. If both pre- and post-contrast sequences are performed in the same session, bill 73223 (without-and-with contrast) — do not stack 73221 and 73222 together.

The code carries a global period of XXX, meaning no global surgical package rules apply — each encounter is billed independently. It is not an ASC-payable service under the current CMS fee schedule; the HOPD rate applies for facility-based imaging. Diagnostic Radiology and IDTFs are the dominant billers, but orthopedic surgeons reading their own studies in a qualifying setting may also report this code.

For arthrogram studies — where contrast is injected into the joint under fluoroscopy or MRI guidance before the MRI scan — the injection procedure (e.g., 23350 for shoulder arthrogram) and any imaging guidance (e.g., 77021 for MRI-guided needle placement) are billed separately alongside 73222. The MRI guidance code 77021 and the arthrogram injection code are distinct from the diagnostic MRI itself; bill all three when all three services are genuinely performed and documented.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.58
Practice expense RVU	7.67
Malpractice RVU	0.11
Total RVU	9.36
Medicare national rate	$312.63
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	$312.63
HOPD (APC 5573) Hospital outpatient department	$800.90

Common denial reasons

The recurring reasons claims for CPT 73222 get rejected.

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

Missing or mismatched laterality — order says left, claim has no LT modifier, or vice versa.
Contrast not documented — payer downcodes to 73221 (without contrast) when contrast administration is absent from the report.
Unbundling error — billing 73221 and 73222 together for a single without-and-with study instead of 73223.
Medical necessity not supported — no documented diagnosis or clinical history justifying contrast use over a standard non-contrast MRI.
Incorrect site-of-service pairing — reporting ASC facility fee alongside 73222, which has no CMS ASC payment rate.
Stacking imaging guidance — billing 77021 bundled into the MRI when guidance was not separately performed and documented.

Frequently asked questions

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

01What is the difference between 73221, 73222, and 73223?

73221 is MRI of an upper extremity joint without contrast. 73222 is with contrast only. 73223 covers both sequences — without and then with contrast — in a single session. If you perform both pre- and post-contrast sequences, bill 73223, not 73221 plus 73222.

02How do I code an MRI arthrogram of the shoulder?

Typically three codes: the arthrogram injection (23350), MRI guidance for needle placement if used (77021), and 73222 for the MRI with contrast. Each must be supported by its own documentation. The AAPC forum consensus and CMS guidance both treat these as distinct billable services when all three are performed.

03Do I need modifier 26 on 73222?

Only if you're billing the professional component separately from the technical component — for example, a radiologist reading a hospital-owned scanner. If you own both the equipment and provide the interpretation, bill the global code without modifier 26.

04Is 73222 payable in an ASC?

No. CMS has no ASC payment rate for 73222 under the current fee schedule. The code is payable under the HOPD rate for facility billing. Confirm with your MAC if outpatient hospital billing applies to your site.

05Can I bill 73222 bilaterally on the same date?

Yes, if both upper extremity joints are imaged with contrast on the same date. Report two claim lines with LT and RT modifiers respectively. The NCCI policy on bilateral diagnostic imaging does not restrict this the same way surgical bilateral rules do — diagnostic procedures follow separate reporting conventions.

06What ICD-10 codes typically support medical necessity for 73222?

Common pairings include codes for internal derangement of a joint, rotator cuff tear, labral pathology, ligamentous injury, osteochondral defect, and suspected avascular necrosis. The diagnosis must specifically justify contrast — payers may question 73222 over 73221 if the clinical scenario doesn't warrant it.

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 joint imaged, laterality, contrast type and route, and the clinical indication from dictation — then flags if the contrast confirmation statement is missing from the report. That prevents the most common 73222 denial: a payer downcode to 73221 because contrast administration wasn't explicitly documented in the final read.

See how Mira captures CPT 73222 documentation