CPT 72131 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 • 11 - Office |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Low |
National average reimbursement for CPT 72131 by major payers:
$171.99
$225.76
$256.18
$258.26
| 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 72131 | ||||||
United | 72131 | $55.81 | 1386770527 - BRIAN BURKE | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Diagnostic Radiology Physician (2085R0202X) |
United | 72131 | $137.42 | 1740453000 - GRAHAM REGIONAL MEDICAL CENTER, GRAHAM GENERAL HSOPITAL PHYSICIANS | 463113489 | TX | General Acute Care Hospital (282N00000X) |
United | 72131 | $42.25 | 1760773717 - AARON FALCHOOK | 596014973 - (FL) SOUTH BROWARD HOSPITAL DISTRICT | FL | Radiation Oncology Physician (2085R0001X) |
United | 72131 | $55.81 | 1629738422 - KASSANDRA GIGLIO | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Nurse Practitioner (363LF0000X) |
United | 72131 | $181.11 | 1093949711 - HEIDI ROLOSON | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Surgical Physician Assistant (363AS0400X) |
United | 72131 | $181.11 | 1215209028 - STEPHANIE SIECHEN | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Physician Assistant (363A00000X) |
United | 72131 | $236.75 | 1205183415 - GRETHE MORTENSON | 251857035 | OR | Nurse Practitioner (363L00000X) |
United | 72131 | $121.08 | 1174788541 - HAIDER KHADIM | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Medical Oncology Physician (207RX0202X) |
United | 72131 | $72.04 | 1407812035 - CHRISTOPHER GLYNN | 251490707 - DUBOIS REGIONAL MEDICAL CENTER | AZ | Anesthesiology Physician (207L00000X) |
United | 72131 | $153.61 | 1396727491 - GAMALIEL RODRIGUEZ-HERRERA | 341855775 | FL | Diagnostic Radiology Physician (2085R0202X) |
United | 72131 | $121.08 | 1942294095 - JOHN SULLIVAN | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Orthopaedic Surgery Physician (207X00000X) |
United | 72131 | $201.33 | 1215209028 - STEPHANIE SIECHEN | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Physician Assistant (363A00000X) |
United | 72131 | $356.60 | 1437131919 - JONATHAN FIELDS | 251857035 | FL | Diagnostic Radiology Physician (2085R0202X) |
United | 72131 | $181.11 | 1265020242 - MACKENZIE MCQUEENEY | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Surgical Physician Assistant (363AS0400X) |
United | 72131 | $60.02 | 1376508846 - DANIEL GRACE | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Maternal & Fetal Medicine Physician (207VM0101X) |
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 72131 vs. Other Diagnostic Radiology (Diagnostic Imaging) Procedures Codes
The CPT 72131 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 72131 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 |
|---|---|---|
| 72131-CPT | Low | Cat Lumbar Spine;W/O Contrst Materl,18-2 |
| 72132-CPT | Moderate | Ct Lumbar Spine;W/Contrast Material |
| 72133-CPT | Moderate | Computerized Axial Tomography Lumbar Spine; Without Contrast Material Followed By Contrast Material(S) And Further Sections |
| 72148-CPT | Moderate | Mri,Spin.Canal,Lumb;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 72131. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 72131 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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