CPT 72128 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Radiology Procedures • Diagnostic Radiology (Diagnostic Imaging) Procedures |
| Common Place of Service | • 23 - Emergency Room • 21 - Inpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 72128 |
National average reimbursement for CPT 72128 by major payers:
$175.00
$226.41
$255.32
$259.23
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 72128 | ||||||
United | 72128 | $189.67 | 1609191493 - KEVIN MCELROY | 201808351 | AZ | Anesthesiology Physician (207L00000X) |
United | 72128 | $108.97 | 1275235426 - EMERUS BHS SA THOUSAND OAKS LLC | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 72128 | $115.58 | 1780655795 - RALPH PICKARD | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Radiology Physician (2085P0229X) |
United | 72128 | $236.00 | 1245658962 - DANIAL MIR | 593425191 - (FL) PEDIATRIC PHYSICIANS SERVICES INC | FL | Vascular & Interventional Radiology Physician (2085R0204X) |
United | 72128 | $371.22 | 1154372423 - KEVIN KROEGER | 202552772 - (MD) PROFESSIONAL SERVICES OF HOLY CROSS | OH | Diagnostic Radiology Physician (2085R0202X) |
United | 72128 | $98.69 | 1023123544 - DERRICK GLYMPH | 562070036 - DUKE UNIVERSITY HEALTH SYSTEM INC | NC | Certified Registered Nurse Anesthetist (367500000X) |
United | 72128 | $207.03 | 1811942238 - KPH-CONSOLIDATION, INC., HCA HOUSTON HEALTHCARE NORTH CYPRESS A CAMPUS OF HCA HOUSTON HEALTHCAR | 621619857 | TX | General Acute Care Hospital (282N00000X) |
United | 72128 | $76.23 | 1023123544 - DERRICK GLYMPH | 562070036 - DUKE UNIVERSITY HEALTH SYSTEM INC | NC | Certified Registered Nurse Anesthetist (367500000X) |
United | 72128 | $248.16 | 1578500401 - VISWESWARA TATINI | 880820406 - (HI) QUEENS UNIVERSITY MEDICAL GROUP | FL | Diagnostic Radiology Physician (2085R0202X) |
United | 72128 | $99.36 | 1174576698 - CHCA BAYSHORE LP, BAYSHORE MEDICAL CENTER | 621801359 | TX | General Acute Care Hospital (282N00000X) |
United | 72128 | $352.57 | 1437131919 - JONATHAN FIELDS | 593214635 - FLORIDA HOSPITAL MEDICAL GROUP INC | FL | Diagnostic Radiology Physician (2085R0202X) |
United | 72128 | $129.69 | 1205183415 - GRETHE MORTENSON | 861385436 | OR | Nurse Practitioner (363L00000X) |
United | 72128 | $292.73 | 1831114685 - BLAINE MITCHELL | 886000436 | FL | Diagnostic Radiology Physician (2085R0202X) |
United | 72128 | $108.97 | 1225381197 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL HAUSMAN | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 72128 | $776.10 | 1326133042 - EDWARD TANG | 943281663 | CA | Anesthesiology Physician (207L00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 72128 vs. Other Diagnostic Radiology (Diagnostic Imaging) Procedures Codes
The CPT 72128 code is part of the Radiology Procedures services used for Diagnostic Radiology (Diagnostic Imaging) Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 72128 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 72128-CPT | Low | Ct Thoracic Spine;W/0 Contrast Mat. |
| 72129-CPT | Moderate | Cat,Thoracic Spine;W/Contrst Materl,18-2 |
| 72130-CPT | Moderate | Computerized Axial Tomography Thoracic Spine; Without Contrast Material Followed By Contrast Material(S) And Further Sections |
| 72146-CPT | Moderate | Mri,Spin.Canal,Thor;W/O Cntrst Matl |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 72128. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 72128 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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