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72265
Quick jump to procedure code: Printer Friendly Version
72275

CPT® 72270: MYELOGRAPHY, 2 OR MORE REGIONS (EG, LUMBAR/THORACIC, CERVICAL/THORACIC, LUMBAR/CERVICAL, LUMBAR/THORACIC/CERVICAL), RADIOLOGICAL SUPERVISION AND INTERPRETATION

Short Description: Myelogphy 2/> spine regions

--

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
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
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ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
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LOUISIANA-Rest of Louisiana
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MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
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MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
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WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2016 Physician
Fee Schedule:

Global Fee $128.26
26 Modifier $ 68.43
TC Modifier $ 59.83

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 JulyUnadjusted OPPS Payment $667.93


*Based on National 2013 Medicare Part B submitted claims.
Revenue Code(s):
320-Radiology diagnostic-general classification


2016 APC Code: 5525
Level 5 X-Ray and Related Services

2016 OPPS Status Indicator: Q2

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
10.6% 724.2    Lumbago M54.5   Low back pain
9.5% 724.02    Spinal stenosis, lumbar region, without neurogenic claudication M48.06   Spinal stenosis, lumbar region
7.7% 724.5    Backache, unspecified M54.89   Other dorsalgia
OR:
M54.9   Dorsalgia, unspecified
7.2% 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
7.2% 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
5.9% V45.4    Arthrodesis status M96.0   Pseudarthrosis after fusion or arthrodesis
OR:
Z98.1   Arthrodesis status
5.2% 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
3.6% 723.1    Cervicalgia M54.2   Cervicalgia
3.4% 722.4    Degeneration of cervical intervertebral disc M50.30   Other cervical disc degeneration, unspecified cervical region
3.4% 723.0    Spinal stenosis of cervical region M48.02   Spinal stenosis, cervical 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.

72270 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 72270

CCI and MUE Edits*         Hide this section.

CCI Edits for 72270
Denied Codes (1)
Effective
Modifier
Accepted (2)
62302 Myelography lumbar injection
01/01/2015 Yes
62303 Myelography lumbar injection
01/01/2015 Yes
62304 Myelography lumbar injection
01/01/2015 Yes
62305 Myelography lumbar injection
01/01/2015 Yes
72125 Ct neck spine w/o dye
07/01/2014 Yes
72126 Ct neck spine w/dye
07/01/2014 Yes
72127 Ct neck spine w/o & w/dye
07/01/2014 Yes
72128 Ct chest spine w/o dye
07/01/2014 Yes
72129 Ct chest spine w/dye
07/01/2014 Yes
72130 Ct chest spine w/o & w/dye
07/01/2014 Yes
72131 Ct lumbar spine w/o dye
07/01/2014 Yes
72132 Ct lumbar spine w/dye
07/01/2014 Yes
72133 Ct lumbar spine w/o & w/dye
07/01/2014 Yes
00600 Anesth spine cord surgery
07/01/2002 No
00620 Anesth spine cord surgery
07/01/2002 No
00625 Anes spine tranthor w/o vent
01/01/2007 No
00626 Anes spine transthor w/vent
01/01/2007 No
00630 Anesth spine cord surgery
07/01/2002 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
01935 Anesth perc img dx sp proc
01/01/2008 No
01936 Anesth perc img tx sp proc
01/01/2008 No
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
62284 Injection for myelogram
01/01/2015 Yes
72240 Myelography neck spine
01/01/1996 No
72255 Myelography thoracic spine
01/01/1996 No
72265 Myelography l-s spine
01/01/1996 No
76000 Fluoroscope examination
06/05/2000 Yes
76001 Fluoroscope exam extensive
06/05/2000 Yes
77001 Fluoroguide for vein device
01/01/2011 Yes
77002 Needle localization by xray
01/01/2007 Yes
77003 Fluoroguide for spine inject
01/01/2007 Yes
99446 Interprof phone/online 5-10
01/01/2014 Yes
99447 Interprof phone/online 11-20
01/01/2014 Yes
99448 Interprof phone/online 21-30
01/01/2014 Yes
99449 Interprof phone/online 31/>
01/01/2014 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 72270.

(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 72270


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Code Descriptor / CPT Instruction Code Descriptor / CPT Instruction 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.


   72270 Top 5 Ordering Providers National*
TED EDWARDS -HUNTSVILLE,AL 316
STEPHEN GRUBB -CHRISTIANSBURG,VA 91
LESLIE SAINT-LOUIS -NEW YORK,NY 80
JACK CONNALLY -DALLAS,TX 74
CHARLES ECKMAN -OKLAHOMA CITY,OK 65

   72270 Top 5 Ordering Organizations National*
ARA/ST. DAVID'S IMAGING, LP-TX 46
SWDIC IMAGING CENTER PARTNERSHIP, LLP-TX 18
MEDITEK/GREYSTONE, INC.-AL 15
PROFESSIONAL IMAGING LLC-MO 12
TULSA MRI, LLC-OK 11

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 72270*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 1,772
Total Services Denied 2015: 449 (25.3%)
National Charges Submitted 2015: $ 1,037,176.00
National Charges Allowed 2015: $ 109,327.00
National Average (No Modifier) Fee Submitted 2015: $476.07
National Average (No Modifier) Fee Allowed 2015: $120.23
National Average (26) Fee Submitted 2015: $244.83
National Average (26) Fee Allowed 2015: $ 57.50
National Average (TC) Fee Submitted 2015: $4462.25
National Average (TC) Fee Allowed 2015: $ 58.96


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 1,052 59.4% $292.87 282 26.8%
Pain Management
(eff. 1/1/02)
489 27.6% $427.91 95 19.4%
Independent Diagnostic Testing Facility
(IDTF)
(eff. 6/98)
91 5.1% $4910.52 19 20.9%
Interventional radiology
(eff 5/92)
41 2.3% $250.99 10 24.4%
Neurosurgery 31 1.7% $598.96 9 29.0%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Outpatient hospital 863 48.7% $246.97 218 25.3%
Office 730 41.2% $485.96 181 24.8%
Inpatient hospital 94 5.3% $235.40 33 35.1%
Ambulatory surgical center 26 1.5% $977.58 16 61.5%
Emergency room - hospital 1 0.1% $261.00 0 0.0%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 984 55.5% $244.85 256 26.0%
No Modifier 583 32.9% $476.07 147 25.2%
TC - Technical Component 102 5.8% $4462.26 27 26.5%
59 - Distinct Procedural Service 78 4.4% $516.45 12 15.4%
52 - Reduced Services 9 0.5% $809.00 2 22.2%

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.

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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08/25/2016 04:37:21 54.81.203.33

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