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CPT Code 73221: MRI, Any Joint of Upper Extremity, Without Contrast

CPT Code 73221 covers MRI of any upper extremity joint without contrast. Learn its uses, billing guidelines, and bring clarity to your revenue.

Use Code

Table of content

What is MRI of upper extremity joint without contrast?Documentation requirements Billing guidelines

Use Code

What is MRI of upper extremity joint without contrast?

CPT code 73221 refers to a magnetic resonance imaging (MRI) procedure of any upper extremity joint, such as the shoulder, elbow, or wrist, performed without contrast material. This MRI imaging test is essential for visualizing soft tissues, bones, and joints and is commonly used when a procedure is necessary to evaluate issues like joint pain, rotator cuff injuries, labral tears, or suspected masses.

This imaging technique helps healthcare providers assess upper extremity problems more clearly by providing detailed images of ligaments, tendons, cartilage, and bone marrow. The technique helps healthcare providers ensure an accurate diagnosis and treatment plan.

A magnetic resonance imaging procedure like CPT 73221 is typically noninvasive and typically required when X-rays or CT scans are inconclusive.

73221 CPT code is most frequently ordered for diagnosing:

Rotator cuff injuries in the shoulder
Labral tears in the shoulder or hip
Ulnar collateral ligament injuries in the elbow or wrist performed for sports injuries
Osteoarthritis and rheumatoid arthritis
Evaluation of tumors or masses in the upper extremity joint

The MRI scan helps healthcare providers visualize the soft tissue structures that are often not visible with other imaging tools.

Documentation requirements

To ensure accurate billing and compliance, the following must be documented clearly:

Specific upper extremity joint imaged (e.g., shoulder, elbow, or wrist)
Medical necessity or indication (e.g., arthritis, injury, soft tissue mass)
Protocol used and component of the service (including type of coil or sequences used)
Final interpretation and diagnostic impression by the radiologist

Billing guidelines

Here are some important guidelines for billing CPT code 73221:

Bill per joint imaged. CPT 73221 should be billed once for each joint (e.g., shoulder) that is imaged during the MRI exam.
Modifiers clarify which joint was scanned and indicate whether the MRI was performed on one or both sides. Including the correct modifier helps ensure accurate billing and appropriate reimbursement for the procedure.
If contrast dye is administered during the exam, use CPT code 73223 instead.
If the service is being billed with professional and technical components, the modifier is used (-26 for professional, modifier TC technical component for technical) to differentiate roles.
This procedure or service is included in the medicare physician fee schedule, so be aware of the respective Medicare Administrative Contractor (MAC) policies.
For code 73221 Medicare reimbursement, always check with your MAC as rules may vary by region. The Medicare Physician Fee Schedules (MPFS) should be consulted regularly for updates to get paid in full.

Following these can accelerate your revenue cycle.

Frequently asked questions

When is it appropriate to report CPT Code 73221 as a repeat clinical diagnostic laboratory test?

CPT Code 73221 may be billed as a repeat clinical diagnostic laboratory test when it is medically necessary to reassess the same upper extremity joint due to new symptoms, progression of a condition, or lack of improvement. Documentation must clearly support medical necessity and indicate that the provider is evaluating changes since the original procedure or service.

How do Medicare guidelines affect billing for CPT Code 73221?

Providers must ensure accurate documentation, correct use of modifiers (such as -RT or -LT), and clear justification for medical necessity. Refer to your Medicare Administrative Contractor (MAC) for any specific local coverage determinations related to this clinical diagnostic laboratory test.

What are other CPT code for MRI?

Magnetic Resonance Imaging (MRI) CPT codes for the upper extremity include the following: 73222, which refers to an MRI of any joint in the upper extremity performed with contrast material; 73223, which describes an MRI performed initially without contrast, followed by contrast material and additional imaging sequences; and 73225, which covers an MRI performed with or without contrast material of any upper extremity joint.