CPT 72295 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • TC - Technical component • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 72295 by major payers:
$143.12
$164.39
$150.00
$197.39
| 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 72295 | ||||||
United | 72295 | $65.31 | 1609950500 - MICHAEL REIDY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | ID | Pulmonary Disease Physician (207RP1001X) |
United | 72295 | $69.01 | 1891026381 - NANCY UDALL | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | FL | Certified Registered Nurse Anesthetist (367500000X) |
United | 72295 | $265.19 | 1881643450 - MACKENZIE LURIE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Physician Assistant (363A00000X) |
United | 72295 | $69.01 | 1831651751 - STEVEN BELCHER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | TX | Certified Registered Nurse Anesthetist (367500000X) |
United | 72295 | $111.88 | 1043795347 - BRIAN HONEKAMP | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Nurse Practitioner (363L00000X) |
United | 72295 | $196.17 | 1932514858 - MARK LIWANAG | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 72295 | $69.01 | 1366762395 - JAMILA WATKINS | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Anesthesiology Physician (207L00000X) |
United | 72295 | $65.31 | 1477843449 - LU PAN | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | CT | Internal Medicine Physician (207R00000X) |
United | 72295 | $69.01 | 1700390861 - DYMAN KWARCIAK | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | IL | Hospice and Palliative Medicine (Family Medicine) Physician (207QH0002X) |
United | 72295 | $65.31 | 1174523161 - AMANDA NEWMAN | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | TX | Certified Registered Nurse Anesthetist (367500000X) |
United | 72295 | $69.01 | 1457538225 - SUSAN DREXLER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Specialist (174400000X) |
United | 72295 | $196.17 | 1053671677 - GREGORY SCHWEITZ | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Emergency Medicine Physician (207P00000X) |
United | 72295 | $108.98 | 1528065919 - DAVID VAN DE WYNGAERDE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Orthopaedic Surgery Physician (207X00000X) |
United | 72295 | $108.98 | 1427051705 - MOHAMMAD KHEDR | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | WI | Critical Care Medicine (Internal Medicine) Physician (207RC0200X) |
United | 72295 | $265.19 | 1457321267 - JASON CARNS | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | 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 72295 vs. Other Diagnostic Radiology (Diagnostic Imaging) Procedures Codes
The CPT 72295 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 72295 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 |
| 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 |
| 72295-CPT | Low | Diskography Lumbar Rad S&I |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 72295. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 72295 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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