Imaging · Knee

Radiologic examination of the knee joint, one or two views, unilateral.

Verified May 8, 2026 · 6 sources ↓

Medicare: $34.40
Total RVUs: 1.03
Global, days
Region: Knee

Drawn from CMSBedrockbillingAAPCFacebook

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify number of views taken (one vs. two) — this determines whether 73560 or 73562 applies.
Document laterality explicitly; LT or RT modifier must align with the report.
Ordering physician's documented clinical indication (fracture, dislocation, osteoarthritis, etc.) to support medical necessity.
If contralateral knee is imaged, document whether it was ordered for diagnostic purposes or comparison only — billing differs.
Radiologist or interpreting physician must sign and date a formal written report; a tech worksheet is not sufficient.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 26 Professional component LT Left side RT Right side 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

73560 covers a one- or two-view X-ray of a single knee. It sits at the low end of the knee imaging family — use 73562 when three views are taken, 73564 for four or more views, and 73565 for bilateral standing AP views only. View count documented in the radiology report determines which code applies; if the tech captures three views, 73560 is a downcode and 73562 is correct.

Laterality modifiers LT and RT are required on 73560. The code is unilateral by definition — 73565 is the dedicated bilateral code and carries no laterality modifier. When the contralateral knee is imaged for comparison only (not ordered as a diagnostic study), bill only the symptomatic side. If the ordering physician separately orders both knees for diagnostic purposes and each side is separately documented, bill both sides using the appropriate unilateral code(s) with LT/RT and, where NCCI pairs are in play, modifier XS.

When 73560 is billed same-day with an E/M, Medicare and some commercial payers (notably Humana) require modifier 25 on the E/M to separate it from the imaging. Without modifier 25, the E/M denies. Post-operative knee X-rays taken during a surgical global period to assess hardware or healing are billed with modifier 58 (staged/related) or 79 (unrelated), depending on context — not without a modifier.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.16
Practice expense RVU	0.85
Malpractice RVU	0.02
Total RVU	1.03
Medicare national rate	$34.40
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	$34.40
HOPD (APC 5521) Hospital outpatient department	$88.91

Common denial reasons

The recurring reasons claims for CPT 73560 get rejected.

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

Missing laterality modifier — 73560 is unilateral and requires LT or RT on every claim.
E/M billed same-day without modifier 25, causing the evaluation and management service to deny under bundling rules.
View count mismatch — three views documented but 73560 billed instead of 73562.
Comparison-only contralateral knee billed without a separate physician order and diagnostic indication, triggering a medical necessity denial.
73560 reported as Column 2 code alongside a higher-order knee imaging code, bundled without an appropriate NCCI modifier.

Frequently asked questions

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

01What is the difference between 73560 and 73562?

View count. 73560 covers one or two views of a single knee; 73562 covers three views. If the report documents three views, 73562 is the correct code — billing 73560 is a downcode.

02Do I need a laterality modifier on 73560?

Yes. 73560 is unilateral. Always append LT or RT. Claims submitted without a laterality modifier will deny under Medicare and most commercial payers.

03Can I bill 73560 for the contralateral knee taken for comparison?

Only if the ordering physician separately ordered the contralateral knee as a diagnostic study with its own clinical indication and it is separately documented. A comparison-only view ordered solely to compare with the symptomatic side is not separately billable.

04How do I bill a knee X-ray taken during a surgical global period?

Use modifier 58 if the X-ray is a staged or related service (e.g., post-op hardware check following TKA). Use modifier 79 if the imaging is for an unrelated condition during the global period. Do not bill without a modifier — it will deny.

05Does Medicare require modifier 25 when 73560 is billed with an E/M on the same day?

Yes. Medicare and some commercial payers including Humana require modifier 25 on the E/M to establish that it was a separately identifiable service. Without it, the E/M denies.

06When would I use modifier XS with 73560?

When NCCI bundling edits apply to a same-day code pair and the services were performed on separate anatomical structures (e.g., bilateral knees billed as two unilateral codes). XS signals the distinct anatomical site and carries a modifier indicator of 1, meaning it can bypass the edit when clinically appropriate.

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 number of views taken, the laterality of the imaged knee, and the ordering indication directly from dictation or the operative/clinical note. It flags when a contralateral view is described as 'comparison only' versus a separately ordered diagnostic study — a distinction that determines whether one or two unilateral codes are billable. This prevents the two most common 73560 denials: missing laterality modifiers and view-count mismatches that result in the wrong code from the 73560–73564 family.

See how Mira captures CPT 73560 documentation