CPT code 73522: Bilateral hip X-ray with pelvis, 3-4 views

Key takeaways

CPT Code 73522 describes a radiologic examination of both hips with pelvis when performed, covering exactly 3-4 views.

View counting is critical: 73521 = 2 views, 73522 = 3-4 views, 73523 = minimum 5 views; selecting the wrong code is a common denial trigger.

Whether the AP pelvis counts as a separate view toward the 73521/73522/73523 threshold remains debated among coders and payers; CPT Assistant June 2016 addresses view counting, but document exact views and confirm each payer’s policy rather than assuming the question is settled.

Pabau’s claims management software helps orthopedic and radiology billing teams track view counts, apply correct modifiers, and reduce claim denials.

CPT Code 73522 covers a bilateral hip X-ray, with pelvis when performed, consisting of 3 to 4 total views. It replaced the deleted code 73520 when CMS restructured hip radiology coding effective January 1, 2016, splitting bilateral hip imaging into the current 73521-73523 series by exact view count.

This guide covers the official code descriptor for CPT Code 73522, how to count views accurately, the differences between 73521, 73522, and 73523, applicable modifiers, reimbursement benchmarks, and documentation requirements. It is written for medical coders, radiology billing staff, orthopedic practice administrators, and anyone managing claims in musculoskeletal imaging.

CPT Code 73522: Official descriptor and clinical context

CPT Code 73522 is maintained by the American Medical Association (AMA) as part of the Current Procedural Terminology (CPT) code set. Its official descriptor reads: Radiologic examination, hips, bilateral, with pelvis when performed; 3-4 views.

The code belongs to the Diagnostic Radiology section covering lower extremity imaging (73501-73725). It is classified as HCPCS Level I, meaning it is recognized for Medicare and most commercial payer claims without a separate HCPCS Level II supplement.

Clinically, 73522 is ordered to assess conditions including:

• Osteoarthritis and degenerative joint disease of the hip
• Hip fracture evaluation (stress fracture or post-trauma)
• Avascular necrosis of the femoral head
• Hip dysplasia and developmental deformities
• Pre-operative or post-operative joint assessment
• Monitoring of total hip arthroplasty hardware

Practices tracking osteoarthritis severity alongside imaging findings can pair 73522 orders with a WOMAC osteoarthritis index to document functional status over time.

The “with pelvis when performed” language is important. It means the pelvis view is optional from a clinical standpoint but, when taken, it is included within the 73522 code rather than billed separately. If a radiologist performs an AP pelvis alongside bilateral hip views, the AP pelvis does not generate a separate CPT claim.

Pabau’s claims management software helps radiology and orthopedic billing teams track procedure codes at the point of claim creation, reducing the risk of selecting the wrong tier from the 73521-73523 series.

CPT Code 73522 view-counting methodology: How to determine the right code

The most contested issue in billing this code series is how to count views. CPT Assistant June 2016 addresses how these codes are differentiated by the number of views taken across both hips combined, several months after CPT Code 73521, 73522, and 73523 took effect on January 1, 2016.

The thresholds are:

The AP pelvis view-counting debate is well-documented in coder forums, including AAPC discussions. Some coders count the AP pelvis as a separate view, pushing a 4-view study to 73523; others count bilaterally symmetrical views as one view per side.

CPT Assistant June 2016 states that each individual projection counts as one view regardless of which side is imaged, which supports counting the AP pelvis as its own view.

That guidance has not settled the debate: coders and payers remain split on how strictly to apply it, and some payers still downcode or request additional documentation when an AP pelvis pushes a study into the 4-view range.

Document the specific views acquired in the radiology report, and confirm the view-counting methodology each payer expects, before billing based on a disputed threshold. The knee equivalent, M17.12 (unilateral primary osteoarthritis, left knee), follows a comparable logic once laterality for a joint diagnosis is confirmed, and it is worth the same documentation discipline.

For orthopedic and chiropractic practices managing high volumes of musculoskeletal imaging claims, systematic view documentation at the technologist level is the most reliable way to avoid downcoding or upcoding on audit. Coders at chiropractic practices frequently encounter this series when billing post-adjustment imaging alongside CPT Code 98940 for the manipulative treatment itself, or during initial workup studies.

Modifiers applicable to CPT Code 73522

Modifier usage for CPT Code 73522 follows standard radiology billing conventions. The most commonly applied modifiers are:

• Modifier 26 (Professional Component): Appended when the physician provides only the interpretation and report, not the equipment or facility. Common when the radiologist reads studies performed at a separate facility.
• Modifier TC (Technical Component): Appended when the facility bills only for equipment, technologist, and overhead costs. The interpretation is billed separately by the reading physician.
• Modifier 52 (Reduced Services): Used when fewer views than the code minimum are performed due to patient tolerance or clinical circumstances, but the study still warrants the code. Use with caution and full documentation.
• Modifier 59 (Distinct Procedural Service): Applied when 73522 is billed alongside another imaging code on the same date that might otherwise trigger an NCCI edit. Document clinical necessity for each procedure.
• Modifier LT / RT: Not applicable for bilateral codes. 73522 is inherently bilateral; appending LT or RT creates a contradictory claim.

The National Correct Coding Initiative (NCCI) applies bundling edits across the hip imaging code family. Billing 73522 alongside 73521 or 73523 on the same date for the same patient will trigger an edit. Only one code from the 73521-73523 series should appear per claim per date of service per patient.

Claims that combine imaging with durable medical equipment, such as a knee orthosis (HCPCS L1845) for a patient with combined hip and knee involvement, require separate modifier logic for each code family.

Practices using physical therapy practice management software that handles imaging referrals should configure modifier logic at the billing template level to prevent incorrect modifier combinations from going out on claims automatically. For a broader look at how PT claims interact with imaging orders, see our physical therapy billing guide.

CPT Code 73522 reimbursement and Medicare fee schedule

Medicare reimbursement for CPT Code 73522 is determined annually through the CMS Medicare Physician Fee Schedule (MPFS). Rates vary by geographic locality (adjusted by Geographic Practice Cost Index, or GPCI) and by whether the global, professional component (Modifier 26), or technical component (TC) is billed.

Actual dollar amounts vary substantially by year, geographic locality, and facility setting, so a single quoted rate becomes outdated quickly. Query the CMS fee schedule directly to retrieve current Work RVU, Practice Expense RVU, and Malpractice RVU values for 73522 by locality before building it into a fee estimate or contract negotiation.

Key reimbursement factors for CPT Code 73522:

• Global billing: The highest reimbursement tier, applicable when one entity performs and reads the study.
• Professional component (Modifier 26): Typically 20-30% of the global fee for diagnostic radiology codes.
• Technical component (TC): Typically 70-80% of the global fee.
• Facility vs. non-facility rates: CMS pays different rates depending on the setting. Outpatient hospital settings often reimburse at facility rates, which are lower than non-facility (office) rates for the professional component.
• Commercial payer rates: Negotiated separately and commonly run at 110-150% of Medicare for radiology services, though this varies significantly by payer contract.

Coders managing IVF or multi-specialty practices that bundle imaging with procedural billing may find it useful to cross-reference IVF CPT codes alongside radiology codes when a patient presents for both fertility workup and pelvic imaging on the same date.

Documentation requirements for CPT Code 73522

Clean documentation is the primary defense against audit and denial for CPT Code 73522. Medical necessity must be established through the clinical record before the study is performed, and the radiology report must confirm what was actually imaged.

The office visit that generates the order, whether billed as a new patient encounter such as CPT Code 99202 or an established patient visit, should document the exam findings that justify bilateral imaging.

Required elements in the ordering record

• Clinical indication supported by a corresponding ICD-10-CM diagnosis code (e.g., M16.0 for primary osteoarthritis of hip, bilateral; S72.001A for displaced femoral neck fracture; or S72.91XH for an unspecified femur fracture)
• Physician order specifying bilateral hip imaging with the number of views or view types requested
• Documentation of symptoms, exam findings, or prior imaging results that justify bilateral rather than unilateral study

Required elements in the radiology report

• Explicit list of views acquired (e.g., “AP pelvis, frog-leg lateral left hip, frog-leg lateral right hip”), with the total view count stated or determinable
• Attestation that both hips were imaged (confirms “bilateral”)
• Statement noting whether the pelvis was imaged (“with pelvis when performed” portion of the descriptor)
• Radiologist interpretation and signature
• Date of service matching the claim

If the radiology report lists only “AP and lateral hips bilaterally” without specifying view count, the coder must determine from the technologist’s log or DICOM metadata whether three or four projections were captured. Underdocumented reports are the leading cause of downcoding from 73522 to 73521 on audit.

Practices that also field hip and pelvic pain complaints can standardize intake with a pain assessment intake form, capturing onset, laterality, and prior imaging before the radiology order is even written.

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ICD-10 crosswalk: Common diagnosis codes paired with CPT Code 73522

Pairing CPT Code 73522 with the correct ICD-10-CM code establishes medical necessity for bilateral hip imaging. Payers cross-reference the diagnosis against the procedure at adjudication; a mismatch is a fast path to denial.

A nonspecific complaint code such as M25.559 (pain in unspecified hip) can support the initial order, but the confirmed post-imaging diagnosis should replace it once the radiologist’s findings are available. Common ICD-10 pairings include:

Musculoskeletal diagnosis codes outside this crosswalk, such as M45.2 (ankylosing spondylitis, cervical region), follow the same specificity rules even though they would not typically justify a hip X-ray on their own; the diagnosis has to match the joint being imaged.

Coders at sports medicine practices pair 73522 with hip impingement or stress reaction codes when bilateral screening is part of pre-season or return-to-play protocols, often alongside a sports physical form completed the same visit. The clinical record must support bilateral imaging; a unilateral complaint with no contralateral findings will not sustain a bilateral claim on audit.

Common denial reasons and how to prevent them

Denial patterns for CPT Code 73522 fall into three predictable categories. Addressing each at the front end eliminates the vast majority of post-submission rework.

Wrong code from the 73521-73523 series

Selecting 73522 when the radiology report supports only 2 views (73521) or 5 or more views (73523) is the most audited error in this code family. Coders should never select the code before reviewing the complete radiology report. Billing from the order alone without verifying the actual views performed creates systematic exposure.

Missing medical necessity documentation

Medicare and most commercial payers require the ordering record to document why bilateral imaging is clinically justified. A chart note that documents only right hip pain without explaining why bilateral X-rays were ordered will fail medical necessity review. The ordering physician must note bilateral symptoms, screening risk factors, or comparative need.

Incorrect modifier or unbundling errors

Applying LT or RT to a bilateral code, billing 73522 alongside another code in the 73521-73523 family, or splitting global services incorrectly between facility and professional claims generates NCCI-triggered denials. These are preventable with claim scrubbing logic configured at the billing system level.

Practices that manage both radiology billing and administrative workflows benefit from centralizing claim creation. Linking digital patient intake forms to the billing workflow captures clinical indication data at the point of registration, making it easier to support medical necessity at adjudication without chart-chasing after the fact.

For broader context on how imaging codes are priced across payer types, review the procedure code fee schedule reference.

Code history: What replaced CPT Code 73520

CPT Code 73520 was deleted effective January 1, 2016, as part of the AMA’s restructuring of hip radiology codes. The old 73520 was used to report bilateral hip imaging consisting of one AP pelvis view and one frog-leg lateral view of each hip (three views total). That three-view study is now reported under CPT Code 73522.

The 2016 restructuring created distinct codes for unilateral hip imaging (73501-73503) and bilateral hip imaging (73521-73523), replacing a fragmented prior approach where bilateral studies were reported by doubling unilateral codes with Modifier 50. The new structure was designed to eliminate modifier confusion and align billing more precisely with actual views performed.

Practices that trained billing staff on the pre-2016 system should audit their superbills and charge capture templates to confirm no legacy references to 73520 or Modifier 50 bilateral pairings remain in current workflows. The AAPC Codify CPT lookup provides current code status flags, including deleted code markers, for the entire lower extremity imaging range.

Practices managing a broad mix of procedure codes, including those combining radiology with behavioral health or primary care billing, may also find the coaching CPT codes reference useful for understanding how the AMA structures non-imaging code families differently from radiology series. Understanding the structural logic behind each code family reduces cross-category coding errors.

For practices managing HIPAA compliance for medical offices that include radiology departments, the 2016 code changes also require updated documentation templates and charge capture forms that reflect the current 73521-73523 structure. Outdated superbills are a common finding in payer audits of orthopedic practices.

Conclusion

CPT Code 73522 is straightforward in principle but frequently miscoded in practice. The view count is the deciding factor between 73521, 73522, and 73523, and getting it right starts with the radiology report, not the order. Explicit documentation of each projection taken, combined with a clear clinical indication for bilateral imaging, is what keeps this claim clean on audit.

Pabau’s claims management tools help orthopedic, radiology, and sports medicine billing teams build the guardrails that prevent 73521-73523 miscoding before claims go out. To see how Pabau supports radiology and musculoskeletal billing workflows, book a demo.

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