August 7, 2025
Medical billing can feel like a code, and in a system, it is. CPT codes like CPT Code 72157 are critical to healthcare reimbursements, yet they often confuse even seasoned medical professionals.
This guide will help you avoid billing difficulties and improve compliance by decoding what this procedure code means, who can bill it, and how to use it accurately.
CPT Code 72157 refers to an MRI of the backbone canal and substances, with and without contrast, with the use of distinction resources. Specifically, it’s used when imaging is required to evaluate spinal issues using both non-contrast and contrast-enhanced techniques.
A standard scan includes multiple image sets to enhance diagnostic accuracy. This makes it especially valuable when conditions such as tumors, inflammation, or multiple sclerosis are suspected.
It’s more comprehensive than the MRI lumbar spine without contrast CPT code and is often compared with the 72141 and 72158 CPT codes, which cover similar imaging procedures with different contrasts or anatomical scopes.
Billing for CPT Code 72157 is limited to:
Providers must make sure they have the appropriate credentials and documentation to support the use of this code, particularly when billing for both the technical and professional components.
The 72157 CPT procedure code covers:
It’s often used in diagnosing spinal cord abnormalities, disc issues, post-surgical complications, and other central nervous system disorders.
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Common modifiers used with CPT Code 72157 include:
Use the correct modifiers is important to avoid denials and ensure correct payment. Misuse may cause misunderstanding with interrelated codes like CPT code 21499 (unlisted musculoskeletal service) or CPT code for VRAM flap.
Avoid these frequent pitfalls:
Always double-check payer-specific guidelines and confirm that medical necessity is documented.
Reimbursement varies based on payer and location. However, national average Medicare reimbursement for CPT Code 72157 typically ranges between $350–$500.
This includes both technical and professional components. Ensure compliance to avoid recoupment.
CPT Code | Description |
72157 | MRI spine w/ & w/o contrast |
MRI spine w/o contrast | |
72158 | MRI spine with/ contrast only |
CPT Code 21499 | Unlisted musculoskeletal service |
CPT Code for VRAM flap | Used in complex reconstructive surgeries (not imaging-related) |
CPT Code Belgium | May refer to European procedure code equivalents (non-U.S.) |
Understanding these differences helps avoid billing mistakes and ensures the correct code reflects the performed service.
Getting to grips with CPT Code 72157 can feel overwhelming, but with accurate knowledge and best practices, it’s completely manageable. Remember to verify medical necessity, include precise documentation, and use proper modifiers.
Stay informed about updates to CT CPT Codes, CT abdomen and pelvis with contrast CPT, and CT chest CPT code if you’re billing related services. This comprehensive understanding allows providers to bill confidently and compliantly.
CPT Code 72157 is used for an MRI of the spinal canal with and without contrast to assess conditions like tumors, inflammation, or spinal cord issues.
CPT 72157 includes both with and without contrast imaging, while CPT 72158 includes only the contrast-enhanced portion.
Medicare typically reimburses $350–$500 for CPT Code 72157, depending on whether both technical and professional components are billed.
Common modifiers include -26 (professional component), -TC (technical component), and -59 for distinct procedural services.
Yes, imaging centers, hospitals, and radiologists can bill this code if the procedure meets medical necessity and is documented properly.
No, it’s not time-based. However, providers should document the procedure time and contrast administration for compliance.
Avoid billing errors by including contrast documentation, applying correct modifiers, and verifying payer-specific coding guidelines.
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