CPT 72197 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
National average reimbursement for CPT 72197 by major payers:
$447.27
$644.73
$635.75
$723.90
| 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 72197 | ||||||
United | 72197 | $139.50 | 1003176710 - EVELYN LORENTS | 953365198 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $824.01 | 1851703185 - NICHOLAS STRLE | 730793134 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $134.25 | 1235208638 - DEREK BURDENY | 941700729 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $91.80 | 1003176710 - EVELYN LORENTS | 260799572 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $423.80 | 1003176710 - EVELYN LORENTS | 264263364 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $1004.44 | 1760434955 - BYRON CHRISTIE | 473109067 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $349.47 | 1548655343 - MEHYAR HEFAZI TORGHABEH | 730757033 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $824.01 | 1750516415 - SAMEER ZAFAR | 474897030 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $1170.03 | 1639218894 - ROBERT FAILS | 863284696 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $637.40 | 1821112699 - OANA MISCHIU | 943302014 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $295.17 | 1003176710 - EVELYN LORENTS | 264263364 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $427.10 | 1952662363 - JULIA KNARREBORG | 730793134 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $337.13 | 1508912403 - JUSTIN MCCOY | 934163254 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $512.03 | 1306023809 - DIMPLE SHAH | 731357965 | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 72197 | $178.38 | 1003176710 - EVELYN LORENTS | 901116751 | OK | Diagnostic Radiology Physician (2085R0202X) |
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 72197 vs. Other Diagnostic Radiology (Diagnostic Imaging) Procedures Codes
The CPT 72197 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 72197 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 |
|---|---|---|
| 72195-CPT | Moderate | Mri, Pelvis; Without Contrast Material(S) |
| 72196-CPT | Moderate | Magnetic Resonance (Eg, Proton) Imaging, |
| 72197-CPT | Moderate | Magnetic Resonance (Eg, Proton) Imaging, Pelvis; Without Contrast Material(S), Followed By Contrast Material(S) And Further Sequences |
| 72198-CPT | Moderate | Magnetic Resonance Angiography Pelvis W/Wo Contrast |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 72197. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 72197 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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