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 |
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 | $147.11 | 1144203662 - TOPS SPECIALTY HOSPITAL, LTD., TOPS SURGICAL SPECIALTY HOSPITAL | 760246499 - (TX) TOPS SPECIALTY HOSPITAL LTD | TX | General Acute Care Hospital (282N00000X) |
United | 72128 | $265.92 | 1225147234 - BASIM KAHLEIFEH | 562357255 - (KY) BARDSTOWN WOMENS CENTER PLLC | KY | Obstetrics & Gynecology Physician (207V00000X) |
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 | $245.17 | 1306865761 - HOSPITAL SERVICE DISTRICT NO. 1 OF CALDWELL PARISH, CITIZENS MEDICAL CENTER | 720862035 - (LA) CITIZENS MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
United | 72128 | $142.91 | 1740934959 - JARED GROW | 201778316 | AZ | Acute Care Nurse Practitioner (363LA2100X) |
United | 72128 | $48.77 | 1558603803 - FENG JIANG | 232032300 - (PA) MEDICAL IMAGING OF LEHIGH VALLEY, P.C. | CT | Diagnostic Radiology Physician (2085R0202X) |
United | 72128 | $67.52 | 1154324184 - TERRI WILLIAMS-WEEKES | 141338428 - ELLIS HOSPITAL | NY | Pediatric Radiology Physician (2085P0229X) |
United | 72128 | $154.52 | 1699726406 - COLUMBIA MEDICAL CENTER OF PLANO SUBSIDIARY LP, MEDICAL CITY PLANO | 621682203 | TX | General Acute Care Hospital (282N00000X) |
United | 72128 | $166.72 | 1720033947 - ST. DAVIDS HEALTHCARE PARTNERSHIP, L.P., LLP, HEART HOSPITAL OF AUSTIN | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 72128 | $108.97 | 1467129700 - VHS SAN ANTONIO PARTNERS, LLC, NORTHEAST BAPTIST HOSPITAL | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 72128 | $106.91 | 1518941251 - MARIA MATA | 232919472 - UPMC | FL | Diagnostic Radiology Physician (2085R0202X) |
United | 72128 | $76.23 | 1023123544 - DERRICK GLYMPH | 562070036 - DUKE UNIVERSITY HEALTH SYSTEM INC | NC | Certified Registered Nurse Anesthetist (367500000X) |
United | 72128 | $53.90 | 1780655795 - RALPH PICKARD | 363637465 - (IL) HOOPESTON COMMUNITY MEMORIAL HOSPITAL | CO | Pediatric Radiology Physician (2085P0229X) |
United | 72128 | $250.00 | 1538139738 - PETER KALOS | 1538139738 - (AZ) PETER KALOS | AZ | Anesthesiology Physician (207L00000X) |
United | 72128 | $236.00 | 1093701161 - DIANA MARIN | 593425191 - (FL) PEDIATRIC PHYSICIANS SERVICES INC | NY | Pediatric Radiology Physician (2085P0229X) |
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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