CPT Code 73200: CT upper extremity without contrast

Key takeaways

CPT Code 73200 covers computed tomography of the upper extremity performed without contrast material, including the arm, elbow, forearm, and wrist.

Medicare payment splits into a professional component (modifier 26) and a technical component (modifier TC), and unilateral studies need modifier LT or RT.

Thin medical necessity documentation is the most common denial trigger, so the order must say why CT was chosen over MRI or plain radiography.

A study performed without contrast and then with contrast in the same session is CPT 73202, never 73200 and 73201 billed together.

Pabau’s claims management software builds the CMS-1500 claim from the recorded service and submits it through Claim.MD to thousands of US payers.

CPT Code 73200 covers computed tomography of the upper extremity performed without contrast material. It applies to the arm, elbow, forearm, and wrist, and it is billed from what the finalized radiology report says about contrast. This reference covers the AMA descriptor, Medicare payment, ICD-10 pairing, modifier rules, and the denial patterns radiology billing teams hit most.

CPT Code 73200: definition and official descriptor

The American Medical Association (AMA) assigns CPT Code 73200 the descriptor Computed tomography, upper extremity; without contrast material. The code applies to any upper extremity segment when no intravenous contrast agent is given during the study.

CPT Code 73200 sits in the Radiology section of the CPT codebook, under Diagnostic Radiology, Upper Extremity. Its global period is XXX (not applicable), which is standard for diagnostic imaging codes.

Clinical indications: when to order a CT upper extremity without contrast

CPT Code 73200 is ordered when a provider needs cross-sectional bony detail of the upper extremity and intravenous contrast is not clinically indicated. Common scenarios include complex fracture characterization after inconclusive plain films, bone tumor evaluation, foreign body localization, and pre-surgical planning. Orthopedic practices also order it for post-traumatic deformity assessment.

• Fracture evaluation: complex or occult fractures of the radial head, distal radius, or carpal bones not fully characterized on plain radiograph
• Bone tumors and lesions: characterization of osseous lesions, exostoses, or cortical destruction
• Foreign body localization: radio-opaque foreign bodies (metal, glass, gravel) requiring precise depth mapping
• Congenital anomalies: carpal coalition and accessory ossicles of the wrist
• Pre-surgical planning: 3D reconstruction planning for corrective procedures, hardware placement guidance
• Post-surgical assessment: evaluation of healing around metallic hardware when MRI is contraindicated

When soft tissue pathology is the primary concern, CPT 73221 (MRI upper extremity without contrast) is usually the better study. Tendon tears, ligament injuries, and cartilage assessment all fall in that group. Choosing CT over MRI has to be supported by a documented rationale in the chart note or the referral order.

CPT Code 73200 Medicare reimbursement rates and RVU breakdown

The CMS Medicare Physician Fee Schedule (MPFS) publishes the national payment rate for CPT Code 73200 each year. The figures below come from the CMS 2025 RVU file. Geographic Practice Cost Index (GPCI) adjustments then move the allowed amount up or down by locality. Check your own MAC fee schedule before billing.

CMS does not publish a separately reduced facility total for this code. The facility and non-facility totals are both 4.89 RVUs, so the site of service does not change the global allowed amount here.

When a radiologist reads the study at a hospital or imaging center that owns the equipment, the billing splits in two. Modifier 26 covers the professional component, meaning the interpretation and the signed report. Modifier TC covers the technical component, meaning the equipment, the facility staff, and the supplies.

The 4.89 total above is the global figure for the code. On a split claim each component is paid separately, so the two line items together are what add up to the global amount.

ICD-10 codes commonly paired with CPT Code 73200

Every CPT Code 73200 claim needs an ICD-10-CM diagnosis code that establishes medical necessity for a non-contrast CT. Code the confirmed condition rather than the symptom wherever the documentation supports it. The pairings below are the ones that come up most.

Code to the highest level of specificity available. An unspecified laterality code such as M19.029 belongs on the claim only when the documentation genuinely does not name a side. Local coverage determinations (LCDs) can also restrict which diagnoses a MAC will cover for CT upper extremity, so check the applicable LCD first.

Where the foreign body is retained metal rather than an open wound, Z18.11 or Z18.12 carries the retained fragment. Both are secondary codes, so the injury or the encounter reason still leads the claim.

CPT Code 73200 billing guidelines and documentation requirements

A payable CPT Code 73200 claim rests on three linked pieces of documentation. The first is a valid written order. The second is a finalized radiology report. The third is a diagnosis code that justifies non-contrast CT over a cheaper or less invasive study.

Get all three in place before the claim is built, not after it comes back denied.

• Written order: the ordering provider must issue a written or electronic order specifying the body part, modality, and contrast status. A verbal order alone is insufficient for Medicare billing.
• Radiology report: the interpreting physician must produce a signed, finalized report. An unsigned or preliminary report does not satisfy documentation requirements for claim submission.
• Medical necessity justification: the order and the chart note must explain why non-contrast CT was chosen. “Rule out fracture” is inadequate; “comminuted fracture pattern not characterized on AP and lateral radiographs” establishes necessity.
• AUC consultation: the CMS Appropriate Use Criteria program adds a decision-support step and a HCPCS G-code for advanced imaging, covered below.
• Global period: CPT Code 73200 carries a global period of XXX, so no pre-operative or post-operative services are bundled into it.

The claim itself needs every required data element on the CMS-1500 or the 837 electronic file. That includes the rendering provider NPI, the ordering provider NPI, and the correct place of service code. Use 11 for office, 22 for hospital outpatient, and 24 for an ambulatory surgical center.

Modifier usage for CPT Code 73200

Modifier 76 and modifier 77 are easy to swap by mistake. Use 76 when the same radiologist repeats and reads the study. Use 77 when a different physician does.

Prior authorization requirements

Medicare does not universally require prior authorization for CPT Code 73200, but many commercial payers and Medicare Advantage plans do. Insurance eligibility verification should confirm the plan requirement before the scan happens. The request itself needs the clinical indication, the relevant imaging history, and the ordering provider NPI.

The CMS Appropriate Use Criteria (AUC) program would require the ordering provider to consult a qualified Clinical Decision Support Mechanism for advanced imaging, including CT. Enforcement has been delayed repeatedly. Confirm the current status and any HCPCS G-code requirement with CMS before you build the claim around one.

CPT Code 73200 vs 73201 vs 73202: choosing by contrast protocol

Picking the right code in the CT upper extremity family is the cheapest way to prevent a contrast denial. All three codes cover the same anatomy and differ only by contrast protocol, and payers check the descriptor against the report. The chart below shows which protocol supports which code.

A study that begins without contrast and then adds contrast in the same session is coded 73202. Billing 73200 and 73201 separately for that study creates an unbundling edit under the National Correct Coding Initiative (NCCI).

73206 is a common mis-hit in this family. It is CT angiography of the upper extremity with contrast, which belongs on a vascular claim rather than a bone one. It is not the without-then-with study that 73202 describes.

Related CPT codes for upper extremity imaging

Coders working with CPT Code 73200 regularly need to distinguish it from neighboring upper extremity imaging codes. The table below covers the ones that come up in this workflow.

CPT 76377 (3D rendering) can be appended to CPT Code 73200 when the radiologist separately performs and documents the reconstruction. It has to be an independent interpretive service in the written report, not a display feature of the imaging software.

Payer acceptance varies, so verify NCCI bundling edits and payer policy before adding 76377. The AAPC CPT code lookup is a quick way to cross-reference current bundling guidance.

Common billing errors and claim denials for CPT Code 73200

The denial patterns below are the ones radiology and orthopedic billing teams work most often on this code. Each row pairs the cause with the fix that clears it.

Review the applicable denial codes when a CPT Code 73200 claim returns with a CARC (Claim Adjustment Reason Code). Common CARCs for radiology denials include CO-50 (not medically necessary), CO-4 (modifier missing), and CO-97 (bundled service).

How practice management software supports accurate CPT Code 73200 billing

Manual code selection and modifier entry are where the errors above get introduced. Practice management software with a billing module carries the order, the diagnosis and the CPT code onto the claim form as one record. The biller then works from the recorded service instead of re-keying it.

Pabau is practice management software with that billing module built in. Its claims management software builds the CMS-1500 claim from the invoice the visit already produced. A real-time eligibility check before the scan is where a missing prior authorization for advanced imaging shows up.

The claim goes out electronically through Claim.MD, Pabau’s US clearinghouse partner, which reaches thousands of US payers. Claim status comes back into the same record, and the Electronic Remittance Advice flags denied lines for rework. Your team chases exceptions instead of re-reading a payer portal.

Submit CT claims without re-keying the invoice

Pabau builds the CMS-1500 claim from the service already on the invoice, then submits it through Claim.MD to thousands of US payers. Eligibility checks, claim status and ERA all return to the same record.

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Conclusion

The hard part of CPT Code 73200 is not the descriptor. It is making the claim agree with the report on contrast protocol, laterality, and the diagnosis behind the study.

Those three checks belong at order entry, not in the denial queue. A claim fixed before submission costs a minute. The same claim fixed after a CO-50 costs an appeal, a rework cycle, and weeks of aging.

Front-end checking does slow the order down slightly, and most radiology teams find that trade worth making. Book a demo to see how Pabau handles a CT upper extremity claim from order through ERA.

Continue your research

Need to understand clearinghouse submission for radiology claims? Pabau’s Claim.MD clearinghouse guide explains how electronic claims route from the practice out to US payers.

Working through a denial for this code? Clean claim requirements in medical billing covers the data elements payers check before processing any radiology claim.

Want to reduce prior authorization delays? Getting credentialed with insurance companies walks through the provider enrollment steps that affect authorization eligibility.

Frequently asked questions