cpt-code-72148-mri-lumbosacral-spine-without-contrast

The CPT code for MRI lumbosacral spine without contrast is one of the most common radiology procedures charged for by billers in outpatient facilities, yet the procedure is commonly mis-coded, under-documented, and denied payment. The billers misunderstand the without contrast code and mix it up with the with contrast code, use inappropriate modifiers for their billing environment, or use incorrect ICD-10 for the procedure that does not satisfy medical necessity requirements. All these mistakes result in financial losses.

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This guide has all the necessary information on how to properly select and code the procedure for the CPT code for MRI of the lumbosacral spine without contrast.

Comparison Table

What Is the CPT Code for MRI LumboSacral Spine Without Contrast?

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The appropriate CPT code for MRI lumbosacral spine without contrast is CPT 72148. As per the definition by the American Medical Association, the description for CPT 72148 is "magnetic resonance imaging, spinal canal and contents, lumbar; without contrast material."

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CPT 72148 refers to the total lumbar spine MRI study, which includes the lumbo-sacral region, but it does not involve the administration of contrast media during the procedure. The procedure includes the evaluation of vertebrae, intervertebral discs, facet joints, spinal nerve openings, spinal canal, conus medullaris, cauda equina, and other soft tissues using the sagittal and axial imaging techniques with T1, T2, and STIR sequences of the MRI examination.

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However, it must be emphasized that CPT 72148 applies to MRI scans where there is no usage of a contrast agent. In case a gadolinium contrast agent is administered in any part of the process, a new CPT code must be used. Physicians who consistently use the 72148 code irrespective of the administration of the contrast agent may be making a coding mistake.

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Variants of the CPT Codes: Which One Should You Select?

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It is necessary to have an understanding of the various CPT codes for MRI lumbosacral spine without contrast or its equivalent. According to the AMA, there are three basic CPT codes applicable to lumbar spine MRI:

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CPT 72148 – Without Contrast

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This is the code used most often by physicians, and it applies to the case where the procedure does not use any gadolinium contrast material at all. This CPT code applies to most cases where a routine MRI of the lumbar spine is ordered in relation to low back pain, radiculopathy, disc imaging, and degeneration assessment. There will be no contrast injection at all.

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CPT 72149 – With Contrast

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The CPT code 72149 refers to an MRI of the lumbar spine that is done using contrast only, whereby the radiologist uses contrast medium to perform the scan. It is typically employed to examine structures of the spine, including the intervertebral discs, nerve roots, spinal canal, and soft tissues around the spine, especially when a more pronounced image of any abnormalities is required.

CPT Code 72158: Without and With Contrast

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When both without and with contrast images are acquired in the same test, CPT code 72158 is the right code to use. It would be indicated when the referring physician needs the image before and after the contrast. For instance, if the test is ordered to determine whether there is a spinal infection, tumors, or whether the patient has epidural fibrosis or recurrent disc herniation following surgery. Codes 72148 and 72149 cannot be billed individually for the combined image.

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Modifiers to Code 72148: Choosing the Appropriate Setting

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Another important consideration in billing CPT code 72148 for MRI lumbosacral spine without contrast is the choice of the right modifier that indicates whether you, the radiologist, or your facility is billing for the procedure. The radiology professional component is usually separated from the technical component in most outpatient settings; failure to append the appropriate modifier results in either low reimbursement or outright rejection.

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Modifier TC - Technical Component

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The Technical Component modifier (TC) is used to modify CPT 72148 whenever the imaging facility is responsible for charging for the equipment, the imaging facility, the personnel, and the supplies necessary for the MRI test. The radiologist's interpretation services are not considered when billing using 72148-TC. Independent imaging facilities that own their MRI scanning machines and have MRI technicians on board use modifier TC for billing MRI lumbosacral spine.

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Modifier 26 - Professional Component

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Modifier 26 is applied to CPT 72148 whenever the radiologist solely charges for his/her professional service for interpreting the test, preparing a report, and dictating the result. The radiologist doesn't have ownership of the MRI scanning equipment, and neither is he/she liable for the cost of operating the imaging facility.

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Global Billing (No Modifier)

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If an imaging facility owned by a physician performs a test using their equipment and also the interpreting radiologist is a member of the practice, then CPT 72148 can be reported without any modifier. In such cases, the code is considered to be globally billed and paid according to a single price. Reporting global billing if both components are separately owned is an overpayment that will be recouped by an audit. Knowledge about what kind of billing should be used is essential for understanding how to bill the CPT 72148 code for MRI of the lumbosacral spine without contrast.

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Modifier 59 – Distinct Procedural Service

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Modifier 59 should be used in cases when billing CPT 72148 on the same date as any other spine imaging code to show that the procedures involved different anatomical parts or had different indications. For instance, performing lumbar (CPT 72148) and cervical (CPT 72141) MRIs on the same date may require the use of modifier 59.

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Medical Necessity and Documentation Standards for ICD-10 Codes

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Even when the CPT coding is perfect for the CPT code for MRI lumbosacral spine without contrast, the claim will still be denied if the ICD-10 code used does not meet the payer’s requirement for medical necessity. For Medicare and many private payers, there are LCDs for lumbar MRIs that list specific diagnoses as reasons for coverage.

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Accepted ICD-10 codes for lumbar MRI without contrast are:

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• M54.50 – Low back pain, unspecified
• M54.51 – Vertebrogenic low back pain
• M54.40 – Lumbago with sciatica, unspecified side
• M54.41 – Lumbago with sciatica, right side
• M54.42 – Lumbago with sciatica, left side
• M51.16 – Intervertebral disc disorder with radiculopathy, lumbar spine
• M51.17 – Intervertebral disc disorder with radiculopathy, lumbosacral spine
• M48.06 – Spinal stenosis, lumbar spine
• M54.3 – Sciatica
• G54.4 – Lumbosacral radiculopathy, (M54.17 (radiculopathy, lumbosacral)), not elsewhere classified 
• S33.5XXA – Sprain of lumbar spine, initial encounter

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The vast majority of LCDs for Medicare coverage indicate that lumbar MRI should be preceded by an attempt at conservative management, generally consisting of at least four to six weeks of physiotherapy, NSAIDs, or chiropractic manipulation, unless red flags exist, such as urinary retention or incontinence, neurologic deficits, or the presence of infection, tumor, or compression fracture. If conservative management has not been exhausted, CPT codes for lumbosacral spine MRI without contrast often get denied as not medically indicated.

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Clinical indications, history and duration of symptoms, attempts at conservative management, and specific clinical questions that need answering must be documented in the ordering physician's notes. Referral orders such as “back pain – MRI of lumbar spine” lack the needed specificity for Medicare reviewers.

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Most Common Reasons for Denial and Prevention Measures

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Even with its highly structured and organized approach, lumbar MRI requests are still often denied. Here are the reasons for denial in the use of the CPT code for MRI lumbosacral spine without contrast, along with solutions providers can take to prevent denials:

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Denial: Medical Necessity Not Established

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Most common reason for denial. The ICD-10 code utilized fails to satisfy the payer’s LCD requirements, or the clinical note from the ordering physician fails to justify the need for an MRI now. Prevention involves confirming the requirements prior to ordering and including a detailed clinical justification within the notes from the ordering physician.

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Denial: 72148 Billed Along with 72149

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Coding errors involving the billing of 72148 and 72149 in the same claim are automatically bundled under NCCI rules. If both contrast and non-contrast MRIs are done during a single imaging study, the right code would be 72158, which is the combination code for the two.

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Denial: Absence or Inaccuracy of Modifier

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Filing a claim of code 72148 as a global payment, even if the technical and professional portions are billed separately by different companies, leads to overpayment that can be recovered. On the other hand, filing 72148-26 even if the practice charges globally leads to systematic underpayment. This problem can easily be solved through proper billing setup.

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Denial: Failure to Get Authorization

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Several health insurers and managed care organizations need authorization before they provide reimbursement for a lumbar MRI. Filing a claim for CPT code 72148, which involves an MRI of the lumbosacral spine without contrast without any valid authorization number, automatically denies the request. The best way is to verify authorization status before the test is conducted.

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Denial: Referred Physician Does Not Have Credentialing Under Plan

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Certain denial reasons have nothing to do with the actual process of billing for the MRI. One such reason for denial could be that the referring physician does not have their credentialing done under the particular plan.

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Reimbursement Overview: What Providers Can Expect

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Reimbursement payments for the CPT code for MRI lumbosacral spine without contrast will fluctuate widely depending on payer category, billing type, geographical region, and modifier. Below are some examples for the 2025 Medicare fee schedule and average commercial insurer reimbursement levels based on CY2025 MPFS; 2026 rates may differ slightly:

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• Professional Component - Medicare (72148-26): roughly $75-$120 per study based on geographic GPCI adjustment.
• Tech Component - Medicare (72148-TC): roughly $250-$420 per study for outpatient hospital/imaging center use.
• Global - Medicare (72148, no modifier): roughly $330-$550 for a physician-owned imaging center using two components.
• Commercial Insurers: usually reimburses 110%-160% of the Medicare rate, but can differ dramatically across plans and network contracts.
• Medicaid: rate varies by state, but many states provide about 60%-80% of Medicare rates for outpatient imaging services.

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If practices have noticed reimbursement payments lower than these benchmarks, then they may wish to review modifiers usage, global/split billing setup for each payer, and correct coding for each clinical use case.

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Prior Authorization: An Inevitable Component of the Process

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The process of securing prior authorization for lumbar MRIs has become more stringent in the last few years, with most commercial payers and Medicare Advantage plans now mandating the completion of prior authorization processes prior to coverage of 72148 being considered. Failing to follow through with this process is one of the easily avoidable reasons for denial with this CPT code.

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Principles of handling prior authorization effectively include:

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• Identifying the need for authorization during scheduling, not following completion of the MRI procedure.
• Ensuring that the correct CPT code (i.e., 72148 or 72158) is consistent with the authorized procedure.
• Recording the authorization number, the entity that approved, and the date on which the authorization expires.
• Being aware of authorization expiration dates – most authorization periods expire between 60 and 90 days after issuance.

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Traditional Medicare (Fees For Services)

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With Traditional Medicare, prior authorization is not needed to obtain coverage for MRI scans, such as CPT 72148.

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Factors used include:

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• Necessity of the procedure
• Local Coverage Determinations (LCDs)
• Documentation of medical records

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Medicare Advantage (C-Plans)

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On Medicare Advantage, prior authorization is usually required for performing lumbar MRIs.

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These plans need you to:

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• Provide clinical notes
• Indicate failure of non-invasive measures

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Radiology Reports: The Basis of a Legitimate Claim

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Any legitimate claim for CPT code 72148 is founded upon the radiologist’s report. In payer reviews during audits, payers determine if the report supports that the test described in the report is consistent with the code submitted. For instance, a report that states contrast-enhanced findings where the billed code is without contrast creates an inconsistency.

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A proper radiology report for CPT 72148 will contain the following elements:

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• Examination details - the type of imaging study performed, including the technique used, and stating that no contrast was used.
• Clinical indication - what the ordering physician had in mind regarding the reason for the test.
• Findings - assessment of all levels, discs, foramina, facet joints, cord, and cauda equina.
• Impression - conclusions about the significant findings that can answer the referring provider's questions.
• Signature/attestation - radiologist’s credentials and signature attesting to the report.

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Radiology reports that do not contain information concerning the technique used in the test, those that omit the clinical indication, or have findings inconsistent with the billed code, are at risk of rejection during audits

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CPT code 72148 for MRI lumbosacral spine without contrast might seem like a simple matter in and of itself. However, while it is the right CPT code for MRI lumbosacral spine without contrast case involving the lumbar region, it represents a convergence of many elements of the revenue cycle: correct choice among similar codes, application of an appropriate modifier for the billing context, use of ICD-10 in conjunction with CPT 72148 that meets medical necessity criteria, prior authorization management, and documentation that can withstand scrutiny by payers.

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For those medical practices whose processes fail to treat these elements of the revenue cycle as interrelated parts of a whole, problems with denial rates are likely to continue limiting the potential gains of their imaging service line. By embracing a coding intelligence solution such as RapidClaims, facilities are able to transform this process into a coherent system where each claim with CPT 72148 is validated for accuracy before payer submission.

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FAQs

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1. What is the CPT code for MRI Lumbosacral without contrast?

The common CPT code for performing an MRI scan of the lumbar spine without contrast is 72148.

2. Is the sacrum included in CPT code 72148?

Yes, CPT 72148 refers to MRI of the lumbar spine, which will include the lumbosacral portion as well.

3. When do you bill MRI lumbosacral without contrast?

This code would apply when performing an MRI scan of the spine without the use of any contrast agent, usually due to lower back pain, disc prolapse, etc.

4. Should contrast be billed for lumbar spine MRI?

Not applicable. For cases where a contrast agent is used, the billing code would change from 72148 to either 72149 or 72158.

5. What are the documentation requirements for CPT 72148?

The Radiology report should clearly state that the MRI scan was done without contrast and that imaging of the lumbar/lumbosacral spine was done.

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