CodeMap® Report 72148
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2018 ICD-10 Diagnosis Code Set Loaded     


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72147
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72149

72148: Mri lumbar spine w/o dye

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


Short Description: Mri lumbar spine w/o dye

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CPT copyright 2016 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2017 Physician
Fee Schedule:

Global Fee $226.82
* 26 Modifier $ 76.44
* TC Modifier $150.37

2017 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2017 October Unadjusted OPPS Payment $225.91


*Based on National 2013 Medicare Part B submitted claims.
2017 APC Code: 5523
Level 3 Imaging without Contrast

Composite APC: 8007
MRI and MRA without Contrast Composite

2017 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.
Percentage
ICD-10 Code
Description
Related DRG(s)
15.4%
M4806
This diagnosis code is no longer active.
551-552
15.0%
M51.26
Other intervertebral disc displacement, lumbar region
551-552
13.9%
M54.5
Low back pain
551-552
11.0%
M51.36
Other intervertebral disc degeneration, lumbar region
551-552
9.6%
M47.816
Spondylosis without myelopathy or radiculopathy, lumbar region
551-552
4.7%
M54.16
Radiculopathy, lumbar region
551-552
3.0%
M51.27
Other intervertebral disc displacement, lumbosacral region
551-552
2.6%
M51.16
Intervertebral disc disorders with radiculopathy, lumbar region
551-552
2.3%
M43.16
Spondylolisthesis, lumbar region
551-552
1.9%
M47.26
Other spondylosis with radiculopathy, lumbar region
551-552

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

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.

Column 1 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
(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.



Column 2 CCI Edits for 72148
Denied Codes (1)
Effective
Modifier
Accepted (2)
72149 Mri lumbar spine w/dye
01/01/1996 No
72158 Mri lumbar spine w/o & w/dye
01/01/1996 No
72159 Mr angio spine w/o&w/dye
07/01/2011 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
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*
RICHARD HOLGATE -MOUNT PLEASANT,SC 1,735
EDMOND KNOPP -LINDENHURST,NY 1,716
MARK TIMKEN -GAINESVILLE,FL 1,565
STEPHEN HERSHOWITZ -MELVILLE,NY 1,463
LAURA APPLEGATE -VAN NUYS,CA 1,452

   72148 Top 5 Ordering Organizations National*
INOVA HEALTH CARE SERVICES-VA 1,106
STANDUP MRI OF DEERFIELD LLC-IL 1,089
IMAGING CENTER OF WEST PALM BEACH LLC-FL 1,066
ASHEVILLE OPEN MRI LLC-NC 1,024
UNIVERSITY RADIOLOGY NETWORK INC-CA 1,017

*Based on 2015 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 2016: 1,551,818
Total Services Denied 2016: 72,639 (4.7%)
National Charges Submitted 2016: $1,245,049,279.88
National Charges Allowed 2016: $184,856,692.11
National Average (No Modifier) Fee Submitted 2016: $1479.97
National Average (No Modifier) Fee Allowed 2016: $230.23
National Average (26) Fee Submitted 2016: $305.23
National Average (26) Fee Allowed 2016: $ 73.05
National Average (TC) Fee Submitted 2016: $1406.27
National Average (TC) Fee Allowed 2016: $137.20


Top 5 Performing Specialties 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 1,202,838 77.5% $627.57 49,823 4.1%
Independent Diagnostic Testing Facility
(IDTF)
(eff. 6/98)
174,084 11.2% $1682.55 13,903 8.0%
Orthopedic surgery 78,152 5.0% $1218.60 3,059 3.9%
Physical medicine and rehabilitation 19,022 1.2% $1265.52 752 4.0%
Interventional radiology
(eff 5/92)
15,589 1.0% $565.99 788 5.1%

Top 5 Places of Service 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 796,422 51.3% $1207.45 45,113 5.7%
Outpatient hospital 550,337 35.5% $301.55 16,352 3.0%
Inpatient hospital 75,711 4.9% $303.70 4,473 5.9%
Independent Clinic 33,638 2.2% $1747.10 2,823 8.4%

Top 5 Modifiers Submitted 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 883,688 56.9% $305.23 30,215 3.4%
No Modifier 398,946 25.7% $1479.97 28,272 7.1%
TC - Technical Component 183,449 11.8% $1406.27 10,915 5.9%
51 - Multiple Procedures 60,407 3.9% $1510.26 508 0.8%
GA - Advanced Beneficiary Notice (ABN) on File 13,725 0.9% $1402.00 1,253 9.1%

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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