72131 — Ct scan of lower spine without contrast
What the market charges
Across 26,805 negotiated rates, the middle 80% fall between $54 and $371, with a median of $132.
What Medicare pays
Medicare allowed an average of $54 for this code, across 501,287 services billed by 12,819 providers. At the median, the market charges 2.4 times what Medicare pays for this code.
Where this is billed, and what it costs there
The states billing 72131 most, by Medicare service volume, each compared against the national average of $54. Each links to the providers Mishe lists there.
- Texas — 1,002 providers billed it, Medicare allowed $53 — 2% below the national average
- California — 1,160 providers billed it, Medicare allowed $62 — 15% above the national average
- Florida — 935 providers billed it, Medicare allowed $60 — 11% above the national average
- New York — 625 providers billed it, Medicare allowed $65 — 20% above the national average
- Minnesota — 574 providers billed it, Medicare allowed $53 — 2% below the national average
- Illinois — 563 providers billed it, Medicare allowed $49 — 9% below the national average
- Ohio — 511 providers billed it, Medicare allowed $46 — 15% below the national average
- Pennsylvania — 479 providers billed it, Medicare allowed $49 — 9% below the national average
Claim-editing rules
These are National Correct Coding Initiative procedure-to-procedure edits — the rules a payer applies when deciding whether two codes billed together are both payable.
Codes this one absorbs
Billed together, 72131 is the payable code and these are not separately payable. 8 pairs in total.
- 36591 — no modifier can override this edit
- 36592 — no modifier can override this edit
- 72265 — a modifier may allow both to be paid
- 72270 — a modifier may allow both to be paid
- 76380 — a modifier may allow both to be paid
- 96523 — no modifier can override this edit
- 0558T — a modifier may allow both to be paid
- 01922 — no modifier can override this edit
Codes that absorb this one
Billed alongside any of these, 72131 is not separately payable. 13 pairs in total.
- 22511 — a modifier may allow both to be paid
- 22514 — a modifier may allow both to be paid
- 72132 — no modifier can override this edit
- 72133 — a modifier may allow both to be paid
- 77301 — a modifier may allow both to be paid
- 78811 — a modifier may allow both to be paid
- 78812 — a modifier may allow both to be paid
- 78813 — a modifier may allow both to be paid
- 78814 — a modifier may allow both to be paid
- 78815 — a modifier may allow both to be paid
- 78816 — a modifier may allow both to be paid
- 0691T — no modifier can override this edit
Other codes
- 99214 — Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
- 99213 — Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more
- 97530 — Therapy procedure using functional activities
- 99232 — Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes
- 97112 — Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes
- 99233 — Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes
- 88305 — Pathology examination of tissue using a microscope, intermediate complexity
- 99309 — Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes
- 87798 — Detection test by nucleic acid for organism, amplified probe technique
- 98941 — Chiropractic manipulative treatment, 3-4 spinal regions
Deploy this for your team
Every figure on this page came from published payer and Medicare data, assembled by Mishe. The same pricing, claim-editing and care-pathway intelligence runs underneath the plans Mishe operates.
- Contact Mishe to learn how to deploy these resources for your team
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