CPT Code 72148: MRI Lumbar Spine without Contrast

What is CPT code 72148?

CPT 72148 refers to a magnetic resonance imaging (MRI) procedure of the lumbar spine performed without contrast material. This non-invasive imaging procedure is used to evaluate structures in the lumbar region, including the vertebrae, intervertebral discs, spinal cord, and surrounding soft tissues. It is commonly ordered by healthcare providers to investigate symptoms such as lower back pain, nerve compression, herniated discs, or spinal stenosis.

Unlike contrast-enhanced studies, CPT 72148 focuses on initial or routine diagnostic imaging using advanced MRI techniques to capture detailed images without the need for contrast injection. It is often chosen when contrast is not clinically indicated or when assessing general lumbar spine pathology.

Documentation requirements

To support medical necessity and ensure accurate billing, the following elements should be included in the patient’s medical record:

• Clinical indication for the MRI: Clearly state the reason for ordering the scan—e.g., radiculopathy, low back pain, suspected herniated disc, or spinal cord abnormalities.
• Anatomical region: Specify that the imaging is focused on the lumbar spine only. For broader studies (e.g., total spine MRI), additional or alternative codes may apply.
• Symptoms or suspected diagnosis: Link the MRI to a specific set of symptoms or diagnostic questions, such as nerve compression, trauma, or suspected malignancy.
• Procedure performed: Document that the MRI was completed without contrast and include a summary of findings, if available, along with the radiologist’s interpretation.
• Referring provider's order: Ensure a valid order from a licensed practitioner is on file and signed, supporting the clinical decision for this diagnostic test.

Billing guidelines

Accurate use of CPT 72148 requires understanding payer-specific policies and differentiating it from other imaging techniques:

• Use 72148 for lumbar MRI without contrast only: If contrast is later administered or expected from the start, use appropriate contrast CPT codes like 72149 (with contrast) or 72158 (with and without contrast).
• Avoid duplicate coding: Do not bill multiple spine MRI codes (e.g., thoracic spine, cervical spine) unless imaging of each region is performed and properly documented.
• Link to appropriate diagnosis codes: Use ICD-10 codes related to lumbar region pathology, such as M54.16 (radiculopathy, lumbar region) or M51.26 (other intervertebral disc displacement, lumbar region), to support medical necessity.
• Consider payer pre-authorization: Many healthcare providers must obtain prior authorization for MRI procedures to avoid claim denials—especially under commercial plans or Medicare Advantage.
• Ensure accurate coding and documentation: Radiology reports should reflect the procedure performed, anatomical focus, and absence of contrast to comply with accurate coding rules and ensure accurate reimbursement.

Other relevant CPT codes

• 72158: MRI lumbar spinal canal with contrast material
• 72147: MRI thoracic spine without contrast material
• 72156: MRI thoracic spine (middle back) without and with contrast material