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72147
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72149

CPT® 72148: MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL

Short Description: Mri lumbar spine w/o dye

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
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WYOMING-Entire State

2016 Physician
Fee Schedule:

Global Fee $223.92
* 26 Modifier $ 75.96
* TC Modifier $147.97

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 Unadjusted OPPS Payment $273.54
2016 Unadjusted ASC Payment $147.94


*Based on National 2013 Medicare Part B submitted claims.
Revenue Code(s):
612-MRT/MRI-spinal cord (including spine)


2016 APC Code: 5581
Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast

Composite APC: 8007
MRI and MRA without Contrast Composite

2016 OPPS Status Indicator: Q3

* This procedure is subject to the Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Imaging Procedures - CMS Transmittal 1104

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
16.6% 724.2    Lumbago M54.5   Low back pain
13.5% 722.52    Degeneration of lumbar or lumbosacral intervertebral disc M51.36   Other intervertebral disc degeneration, lumbar region
OR:
M51.37   Other intervertebral disc degeneration, lumbosacral region
13.4% 722.10    Displacement, lumbar intervertebral disc without myelopathy M51.26   Other intervertebral disc displacement, lumbar region
OR:
M51.27   Other intervertebral disc displacement, lumbosacral region
12.3% 724.02    Spinal stenosis, lumbar region, without neurogenic claudication M48.06   Spinal stenosis, lumbar region
8.4% 721.3    Lumbosacral spondylosis without myelopathy M47.817   Spondylosis without myelopathy or radiculopathy, lumbosacral region
6.9% 724.4    Thoracic or lumbosacral neuritis or radiculitis, unspecified M54.14   Radiculopathy, thoracic region
OR:
M54.15   Radiculopathy, thoracolumbar region
OR:
M54.16   Radiculopathy, lumbar region
OR:
M54.17   Radiculopathy, lumbosacral region
2.5% 724.5    Backache, unspecified M54.89   Other dorsalgia
OR:
M54.9   Dorsalgia, unspecified
2.3% 738.4    Acquired spondylolisthesis M43.00   Spondylolysis, site unspecified
OR:
M43.10   Spondylolisthesis, site unspecified
1.7% 733.13    Pathologic fracture of vertebrae M48.50XA   Collapsed vertebra, not elsewhere classified, site unspecified, initial encounter for fracture
OR:
M80.08XA   Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
OR:
M84.48XA   Pathological fracture, other site, initial encounter for fracture
OR:
M84.68XA   Pathological fracture in other disease, other site, initial encounter for fracture
1.6% 722.93    Other and unspecified disc disorder, lumbar region M46.47   Discitis, unspecified, lumbosacral region
OR:
M51.86   Other intervertebral disc disorders, lumbar region
OR:
M51.87   Other intervertebral disc disorders, lumbosacral region

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

72148 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 72148

CCI and MUE Edits*         Hide this section.

CCI Edits for 72148
Denied Codes (1)
Effective
Modifier
Accepted (2)
01922 Anesth cat or mri scan
07/01/2002 No
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
72149 Mri lumbar spine w/dye
01/01/1996 No
72158 Mri lumbar spine w/o & w/dye
01/01/1996 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
72159 Mr angio spine w/o&w/dye
07/01/2011 Yes
C8931 Mra, w/dye, spinal canal
07/01/2011 Yes
C8932 Mra, w/o dye, spinal canal
07/01/2011 Yes
C8933 Mra, w/o&w/dye, spinal canal
07/01/2011 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 72148.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 72148


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Anatomic Consideration Anatomic Consideration Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   72148 Top 5 Ordering Providers National*
JAY KAISER -GREENBRAE,CA 1,297
WILLIAM KELLY -PALM DESERT,CA 1,186
JOEL SWARTZ -VILLANOVA,PA 1,159
TIMOTHY GREENAN -ROCKVILLE,MD 1,116
RICHARD HOLGATE -MOUNT PLEASANT,SC 1,109

   72148 Top 5 Ordering Organizations National*
ROSE RADIOLOGY CENTERS INC-FL 2,213
MAINE MOBILE MRI ASSOCIATES-ME 1,086
INOVA HEALTH CARE SERVICES-VA 1,009
UNIVERSITY RADIOLOGY NETWORK INC-CA 923
IMAGING CENTER OF WEST PALM BEACH LLC-FL 899

*Based on 2013 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 72148*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 1,460,494
Total Services Denied 2014: 80,151 (5.5%)
National Charges Submitted 2014: $1,178,219,474.00
National Charges Allowed 2014: $189,739,912.00
National Average (No Modifier) Fee Submitted 2014: $1466.83
National Average (No Modifier) Fee Allowed 2014: $253.21
National Average (26) Fee Submitted 2014: $297.82
National Average (26) Fee Allowed 2014: $ 75.46
National Average (TC) Fee Submitted 2014: $1405.45
National Average (TC) Fee Allowed 2014: $157.75


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 1,112,376 76.2% $623.89 52,657 4.7%
Independent Diagnostic Testing Facility
(IDTF)
(eff. 6/98)
181,852 12.5% $1615.61 18,192 10.0%
Orthopedic surgery 73,979 5.1% $1245.91 3,684 5.0%
Physical medicine and rehabilitation 16,178 1.1% $1287.14 659 4.1%
Neurology 13,464 0.9% $963.60 778 5.8%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 767,757 52.6% $1214.95 55,914 7.3%
Outpatient hospital 559,014 38.3% $295.86 16,598 3.0%
Inpatient hospital 76,878 5.3% $298.43 3,473 4.5%
Emergency room - hospital 25,750 1.8% $292.85 1,418 5.5%
Other unlisted facility 2,362 0.2% $1962.31 196 8.3%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 815,785 55.9% $297.82 27,593 3.4%
No Modifier 400,835 27.4% $1466.83 38,068 9.5%
TC - Technical Component 170,756 11.7% $1405.45 11,988 7.0%
51 - Multiple Procedures 48,369 3.3% $1497.37 407 0.8%
GA - Advanced Beneficiary Notice (ABN) on File 12,123 0.8% $1365.50 878 7.2%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


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All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

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04/29/2016 08:24:06 54.90.217.218

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