CPT code 73020 – Single-view shoulder radiograph

Key takeaways

CPT code 73020 covers one shoulder X-ray projection, and a report listing two or more views bills as 73030 instead.

Modifiers -26 and TC split the professional and technical components, while -RT and -LT show which shoulder was imaged.

Bilateral shoulder films go on two lines, one with -RT and one with -LT, because modifier -50 doesn’t apply to this code.

Pair 73020 with a side-specific ICD-10-CM code whose laterality matches the modifier on the claim line.

A view count that doesn’t match the signed report and a missing laterality modifier are two denials you can catch before submission.

CPT code 73020 covers one view of one shoulder

CPT code 73020 reports a single-projection X-ray of the shoulder. The American Medical Association (AMA), which maintains the CPT code set, publishes the official descriptor as Radiologic examination, shoulder; one view.

That descriptor is what an auditor checks the claim against. If the radiology report documents two views, the correct code is 73030, however the order was written. The billed code has to reflect what was performed and documented.

What counts as one view

A single view means one image acquisition in one radiographic projection. The anteroposterior (AP) view is the most common single shoulder film. A Grashey view, scapular Y or axillary projection can also be the only view taken. Only the number of distinct projections in the final report decides between 73020 and 73030.

When a single film is enough

Ordering clinicians choose one view when a quick, limited look answers the clinical question. Typical scenarios include:

• Post-reduction check after an acute shoulder dislocation
• Implant position confirmation following arthroplasty
• Rapid trauma screening in the emergency department
• Monitoring a known fracture at a follow-up visit
• Pre-procedure baseline in a patient with a known rotator cuff disorder

A full diagnostic picture of the joint usually needs two or more projections. That moves the study to 73030.

73020 vs 73030: The view count picks the code

73030 is the code most often confused with 73020. The two differ only in how many projections the signed report lists, so the comparison below comes down to one question.

Billing 73030 for one documented view is upcoding, and payers can audit the claim or recoup the payment. Billing 73020 when two views were taken is undercoding, which leaves money unpaid. In both cases, the fix is to match the code to the documented view count.

Neighboring codes cover arthrography, the humerus and the elbow

CPT code 73020 sits in a family of upper-extremity X-ray codes. Coders reach for these when a patient has several areas imaged in the same encounter.

Two neighbors cause most of the mix-ups. 73040 is shoulder arthrography, which is a contrast study rather than a plain film. 73060 images the humerus, so it isn’t a substitute for a shoulder view.

Modifiers on 73020 show who billed and which side

Modifiers tell the payer how the service was delivered and who is billing which component. A wrong or missing modifier on 73020 is a quick route to a denial.

Component modifiers: -26 and TC

In a hospital or independent imaging facility, two entities often bill for one film. The facility bills for equipment and staff, which is the technical component. The radiologist bills for the interpretation, which is the professional component.

• Modifier -26 (professional component): Appended when the radiologist bills only for the interpretation and report. The facility submits a separate claim for the TC.
• Modifier TC (technical component): Appended when the facility bills only for the equipment, room and technologist time. The radiologist submits a separate -26 claim.
• No modifier (global billing): Used when one provider owns the equipment and also reads the film. This is common in private practices and freestanding imaging centers with employed radiologists.

If both parties send 73020 without a modifier, each one is billing globally for the same film. Payers typically deny one or both claims.

Laterality modifiers: -LT and -RT

Many payers require -LT or -RT on shoulder imaging, so check each payer’s policy. Leaving laterality off is a common reason a 73020 claim comes back.

• Modifier -LT: Left shoulder
• Modifier -RT: Right shoulder
• Both shoulders: Bill two lines, 73020-RT and 73020-LT. Diagnostic radiology carries MPFS bilateral indicator 3, so modifier -50 doesn’t apply.

Medicare pays 73020 by component, so check the MPFS rate

Payment for CPT code 73020 under the CMS Medicare Physician Fee Schedule (MPFS) is built from relative value units (RVUs). A geographic practice cost index (GPCI) then adjusts them for your area. Rates vary by locality and change every year.

Check current rates in the CMS MPFS lookup or the FastRVU lookup tool before you set fee schedules or estimate patient liability. Medicare Advantage and commercial rates can differ widely from traditional Medicare.

ICD-10 codes that support a 73020 claim

Every 73020 claim needs an ICD-10-CM diagnosis code to show medical necessity. The diagnosis must appear in the ordering provider’s notes and be specific enough to justify the film. An unspecified code is a common audit trigger.

ICD-10-CM codes build laterality into the code itself. The diagnosis side must match the -LT or -RT modifier on the claim line. Many payers reject a right shoulder diagnosis paired with -LT automatically.

Prior authorization is rarely needed for a plain shoulder film

Plain shoulder X-rays generally don’t need prior authorization under traditional Medicare fee-for-service. Requirements still vary by payer, so confirm before you assume.

• Traditional Medicare: No prior authorization for CPT code 73020 in most circumstances. The ordering provider must still document the clinical indication.
• Medicare Advantage: Plans may add prior authorization rules that traditional Medicare doesn’t have. Check with the plan before non-urgent studies.
• Commercial payers: Most don’t require prior authorization for standard plain films. Some managed care plans want a referral or order from a primary care physician.
• Medicaid: Rules vary by state. Check the state’s Medicaid fee schedule or provider manual before billing.

Medicare Administrative Contractors (MACs) may publish Local Coverage Determinations (LCDs) with documentation rules for shoulder imaging. Review them regularly, because they can change independently of the national fee schedule.

How a 73020 claim moves from film to payment

Once the film is read, the claim follows a fixed path. Each step adds one piece of the claim line, and a denial usually traces back to one skipped step.

1. The ordering provider documents the clinical indication and the side to be imaged.
2. The technologist takes the film, and the radiologist signs a report naming each projection.
3. The coder counts the projections in the signed report and picks 73020, 73030 or 73040.
4. The coder adds the component modifier, if billing is split, and the laterality modifier.
5. The coder links an ICD-10-CM code whose side matches the modifier.
6. The claim goes out as an 837P file through a clearinghouse to the payer.
7. The payer’s electronic remittance advice comes back with payment or a denial reason code.

Steps three to five are where the coding decisions sit. The chart below runs through them in the order a coder should answer them.

Common reasons 73020 claims are denied, and how to fix them

Most 73020 denials fall into a handful of preventable groups. Each one returns with a reason code on the remittance, and our guide to denial codes explains what each code means.

• Wrong code (73030 billed, 73020 appropriate): The report documents one view, but the claim shows 73030. Fix: check the billed code against the view count in the signed report, not the order.
• Wrong code (73020 billed, 73030 appropriate): Two views were documented, but 73020 was billed. This is undercoding and loses revenue. Fix: the same reconciliation step, with the report as the authority.
• Missing laterality modifier: The claim has no -LT or -RT, and the payer requires one. Fix: add the modifier at claim entry and check it against the report and the diagnosis code.
• ICD-10 laterality mismatch: A right shoulder diagnosis sits on a -LT line, or the reverse. Fix: cross-check the modifier side against the diagnosis side before submission.
• 73020 and 73030 on the same date: Both codes were billed for the same shoulder in one session. Payers usually deny one line. Fix: bill the single code that matches the total views.
• Missing -26 or TC in split billing: The radiologist and the facility both bill globally for one film. Fix: confirm the billing arrangement and apply the right component modifier on each claim.
• Weak medical necessity: The diagnosis doesn’t support the film, or the order lacks an indication. Fix: confirm the order names an explicit indication that maps to a billable ICD-10-CM code.

A worked example

A patient falls and the order reads “right shoulder X-ray, one view.” The technologist takes an AP view and then adds a scapular Y view. The signed report lists both projections.

The correct line is 73030-RT with S40.011A, not 73020. Billing from the order would undercode the study, and the report would contradict the claim at audit.

When denials keep repeating, track them by reason and fix the step that causes them. This overview of denial management in healthcare shows how practices track, appeal and prevent repeat rejections.

Documentation that holds up in a 73020 audit

Documentation is what defends a 73020 claim when a payer or auditor asks. The radiology report and the order together form the billing record.

What the radiology report must contain

• An explicit statement of the number of views taken, such as “AP view of the right shoulder”
• The named projection for each view
• The radiologist’s interpretation and findings
• The radiologist’s signature and date of interpretation
• The ordering provider’s name and clinical indication
• The performing facility or practice name

Why one view must be explicit

An audit of a 73020 claim goes straight to the radiology report. If the report lists two projections, the auditor treats the claim as undercoded. If it lists one projection and the claim shows 73030, that is upcoding the payer can recoup.

Writing “one view” in the dictation, instead of leaving it implied, costs the radiologist a few words. It also removes doubt for coders who pick up the report later.

Before you submit: A 73020 checklist

• The view count in the signed report matches the CPT code billed.
• The laterality modifier matches the side in the report.
• The ICD-10-CM code’s side matches the -RT or -LT modifier.
• The component modifier (-26 or TC) is present if billing is split.
• Bilateral films are on two lines, not one line with -50.
• The order carries a clinical indication that supports the film.

How claims software keeps 73020 claims complete

Without connected software, a biller copies the view count, side and diagnosis from the report into a claim form by hand. Each copied field is another chance to drop -RT or bill the wrong view count.

Pabau, the practice management and billing platform we build, pre-fills the claim form from the patient record. Its claims management software includes ICD-10 and CPT lookup libraries, so the biller finds 73020 and the diagnosis in one place. Before you press Send, Pabau checks that the required claim fields are complete.

Claims go out through the Claim.MD clearinghouse, with eligibility checks where the payer supports them. Electronic remittance advice brings each payer’s response back, including the reason code behind any denial. Your team can work a denial the day it arrives.

Send complete radiology claims the first time

Pabau pre-fills each claim from the patient record and checks required fields before you send. Claims go out through Claim.MD, and remittances come back to the same record.

Book a demo

Conclusion

Treat the signed radiology report as the source for every 73020 claim line. The view count picks the code, and the side picks the modifier. The diagnosis then has to agree with both.

When those three line up, a one-view shoulder film is one of the simpler claims a practice sends. The trade-off is a short check before submission against an appeal and resubmission after a denial.

If you want those checks built into your billing day, book a demo to see how Pabau pre-fills radiology claims from the patient record.

Continue your research

Need to understand how electronic claims reach payers? Claim.MD clearinghouse overview explains how 837P files are validated and routed to payers.

Want to reduce denials before they happen? What makes a clean claim covers the pre-submission checks that stop the most common rejections.

Imaging the elbow in the same visit? CPT code 73070 covers the two-view elbow study and how it differs from 73080.

Looking for the broader medical billing picture? Revenue cycle management basics maps how a single claim like CPT 73020 fits the full patient-to-payment workflow.

Frequently asked questions