CPT 72265 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 • 59 - Distinct Procedural Service • 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 72265 |
National average reimbursement for CPT 72265 by major payers:

$138.20

$141.50

$133.75

$175.53
| 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 72265 | ||||||
United | 72265 | $1609.16 | 1619985942 - CATHOLIC HEALTH INITIATIVES COLORADO, CENTURA ST ANTHONY NORTH HOSPITAL | 840405257 - CATHOLIC HEALTH INITIATIVES COLORADO | CO | General Acute Care Hospital (282N00000X) |
United | 72265 | $714.85 | 1508859661 - MERCY HOSPITAL JEFFERSON, JEFFERSON MEMORIAL HOSPITAL ASSOCIATION | 430687077 - (MO) MERCY HOSPITAL JEFFERSON | MO | General Acute Care Hospital (282N00000X) |
United | 72265 | $715.17 | 1255995361 - VHS OF PHOENIX INC, ABRAZO MESA HOSPITAL | 621809851 | AZ | General Acute Care Hospital (282N00000X) |
United | 72265 | $1710.02 | 1336378132 - ROTHMAN ORTHOPAEDIC SPECIALTY HOSPITAL, LLC, BUCKS COUNTY SPECIALTY HOSPITAL, LLC | 270260289 - (PA) ROTHMAN ORTHOPAEDIC SPECIALTY HOSPITAL LLC | PA | General Acute Care Hospital (282N00000X) |
United | 72265 | $1666.68 | 1851927669 - NORTHWEST SAHUARITA HOSPITAL LLC, NORTHWEST MEDICAL CENTER SAHUARITA | 384088744 - (AZ) NORTHWEST SAHUARITA HOSPITAL LLC | AZ | General Acute Care Hospital (282N00000X) |
United | 72265 | $992.60 | 1225133473 - MONMOUTH MEDICAL CENTER INC, MONMOUTH MEDICAL CENTER SOUTHERN CAMPUS | 223452412 | NJ | General Acute Care Hospital (282N00000X) |
United | 72265 | $597.27 | 1851343909 - VICTORIA OF TEXAS LP, DETAR HEALTHCARE SYSTEM | 621754940 | TX | General Acute Care Hospital (282N00000X) |
United | 72265 | $1361.64 | 1023061405 - AFFINITY HOSPITAL LLC, GRANDVIEW MEDICAL CENTER | 203391873 | AL | General Acute Care Hospital (282N00000X) |
United | 72265 | $1644.01 | 1609971019 - SCURRY COUNTY HOSPITAL DISTRICT, COGDELL MEMORIAL HOSPITAL | 752403687 - (TX) SCURRY COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 72265 | $399.27 | 1437188216 - DMC-MEMPHIS, LLC, DELTA SPECIALTY HOSPITAL | 621650705 - (TN) DMC - MEMPHIS, INC. | TN | General Acute Care Hospital (282N00000X) |
United | 72265 | $173.52 | 1548750417 - UKHS GREAT BEND, LLC, THE UNIVERSITY OF KANSAS HEALTH SYSTEM GREAT BEND CAMPUS | 830516935 | KS | General Acute Care Hospital (282N00000X) |
United | 72265 | $816.97 | 1073576740 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE HEALTH | 860830701 | AZ | General Acute Care Hospital (282N00000X) |
United | 72265 | $715.17 | 1003344334 - HCN EP HORIZON CITY, LLC, THE HOSPITALS OF PROVIDENCE HORIZON CITY CAMPUS | 813935393 - (TX) HCN EP HORIZON CITY LLC | TX | General Acute Care Hospital (282N00000X) |
United | 72265 | $1159.19 | 1053321919 - UNIVERSITY COMMUNITY HOSPITAL, INC, ADVENTHEALTH TAMPA | 591113901 - (FL) UNIVERSITY COMMUNITY HOSPITAL INC | FL | General Acute Care Hospital (282N00000X) |
United | 72265 | $3392.75 | 1083888515 - PEACEHEALTH, SACRED HEART-RIVERBEND | 261871008 | OR | General Acute Care Hospital (282N00000X) |
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 72265 vs. Other Diagnostic Radiology (Diagnostic Imaging) Procedures Codes
The CPT 72265 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 72265 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 72265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 72265 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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