CPT code 73552 – radiologic examination, femur, minimum 2 views

Key takeaways

CPT Code 73552 covers a femur radiologic examination with a minimum of two views, and 73551 covers single-view studies.

Medicare’s 2026 national non-facility rate is $35.74, built from 1.07 total RVUs and the $33.4009 conversion factor.

Practice expense RVUs are identical in the facility and non-facility settings for this code, so the setting decides who bills, not how much.

Modifiers -26, -TC, -LT, -RT, and -52 are the ones you will use, and the -26/-TC split causes most denials.

Pabau’s claims management software submits and tracks 73552 claims through the Claim.MD clearinghouse and posts remittances automatically.

CPT Code 73552: official description and clinical context

CPT Code 73552 describes a radiologic examination of the femur, minimum 2 views, as defined by the American Medical Association’s CPT code set. The code sits within the Radiology section of the CPT manual, under diagnostic radiology procedures for the lower extremities.

Clinically, the code applies whenever two or more projections of the femoral shaft or the distal or proximal femur are acquired in one encounter. Anteroposterior (AP) and lateral views are the usual pair. Oblique and additional spot views also satisfy the minimum 2 views requirement.

Clinical indications that support ordering a femur series include:

• Suspected or confirmed femoral shaft fracture (traumatic or stress)
• Evaluation of femoral bone lesions, cysts, or tumors
• Post-operative assessment of femoral hardware or prosthetics
• Monitoring of metabolic bone disease affecting the femur
• Pain or swelling in the thigh without confirmed etiology
• Follow-up imaging for known osteomyelitis or periosteal reaction

The code captures the global service unless it is split-billed with modifiers. When the radiologist personally performs and interprets the study in a private office or a free-standing imaging center, bill 73552 with no modifier. When the facility owns the equipment and the radiologist supplies only the interpretation, apply the -26 and -TC split.

2026 Medicare fee schedule for CPT 73552

Medicare pays CPT 73552 under the CMS Medicare Physician Fee Schedule (MPFS). Rates are set annually and adjusted by the Geographic Practice Cost Index (GPCI) for each Medicare locality. The national unadjusted figures below use the 2026 conversion factor, so your allowable will differ by MAC jurisdiction.

Important: The global figure is 1.07 total RVUs multiplied by the 2026 nonqualifying APM conversion factor of $33.4009. Practices paid on the qualifying APM conversion factor of $33.5675 see $35.92 for the same study. The component amounts are national approximations, and every figure here moves once your locality’s GPCI values are applied.

RVU breakdown

Relative value units (RVUs) set the base payment for 73552 before geographic adjustment. Work, practice expense, and malpractice combine into a total, which is then multiplied by the locality GPCI and the annual conversion factor.

The equal practice expense values are the part worth noting. Because the facility and non-facility figures match, the setting decides who bills which component rather than what the components are worth. Use the FastRVU 2026 RVU lookup tool to confirm the values and run your locality calculation. CMS updates the RVU data files each October for the following calendar year.

Which modifiers to apply, and when

Modifier selection is the highest-risk step in a femur imaging claim. Applying -26 and -TC incorrectly is a leading driver of rework at imaging centers. The chart below sets out the two decisions behind every clean 73552 claim, and the table after it covers each modifier in turn.

Verify modifier applicability against current NCCI edits before submission. Payer policies on the -26 and -TC split vary. Some commercial payers want the global code even when the radiologist and the facility are separate entities. Read each payer’s provider manual before you set a default.

ICD-10 codes commonly paired with a femur series

Every 73552 claim needs a supporting ICD-10-CM diagnosis code that establishes medical necessity. The diagnosis has to appear in the ordering provider’s notes and match the clinical indication on the radiology order. Our ICD-10-CM code library carries the full descriptor and coding notes for each diagnosis below.

The codes below are the ones most often paired with CPT 73552 in orthopedic and radiology practices. They are examples rather than an exhaustive list.

Two traps sit in this table. The M89.8X subcategory is not subdivided by side, so a coder looking for a right or left thigh option will not find one. The seventh character on a trauma code also has to match the stage of care in the note. A marks an initial encounter, D a subsequent one, and S a sequela. Submitting an A code on a follow-up visit is an audit trigger under payer edit systems.

Documentation requirements and medical necessity

A clean 73552 claim needs documentation that ties the clinical indication to the imaging order. Medicare and most commercial payers follow the Local Coverage Determinations (LCDs) issued by the applicable MAC. Those LCDs name the ICD-10 codes and clinical scenarios that support coverage.

The radiology report and the referring provider’s order together establish medical necessity. Here is what reviewers look for in a 73552 audit:

• Written order: signed by the ordering provider, naming the site (femur), the laterality, and the clinical indication
• Medical necessity statement: clinical notes from the referring provider documenting the symptom, injury mechanism, or relevant history that justifies imaging
• View count documentation: the radiology report must explicitly state the number of views acquired, confirming at least two projections to support 73552 over 73551
• Radiologist’s signed interpretation: a structured report with findings, impression, and the interpreting physician’s signature
• ICD-10 alignment: the diagnosis code on the claim must match the clinical indication in the referring provider’s note

Practices that capture view counts by hand often undercode by defaulting to 73551. Automating the charge-capture step, so the view count in the report drives the code selection, removes that error. Most of the work behind a clean claim happens at the point of order, not at billing.

Related CPT codes: 73551 vs 73552

CPT 73551 covers a femur radiologic examination with one view, and CPT 73552 applies when two or more views are acquired. The distinction is simple in principle. Undercoding still happens, usually because the order was placed as “femur X-ray” with no view count and the biller took the lower code.

Decision rule: Read the radiology report, not the order. The order may say “femur X-ray,” but if the report documents an AP and a lateral view, bill 73552. If the report documents a single AP projection because the patient could not tolerate repositioning, bill 73551 and document the clinical reason.

Other lower-extremity radiology CPT codes

73552 sits within a family of lower-extremity diagnostic radiology codes. When the clinical question involves a different anatomical site, select the sibling code for that site rather than stretching 73552 with documentation workarounds.

How Pabau supports radiology billing for femur imaging

Radiology and orthopedic practices billing high volumes of musculoskeletal imaging hit the same three errors. The wrong code goes out when the view count is unclear. A modifier gets left off a split-billed claim. A diagnosis reaches the payer that does not match the indication on the order.

Practice management software like Pabau keeps the code, the modifier, and the diagnosis on one patient record. Pabau’s claims management software then submits that record as a claim, so what the payer receives matches what the radiologist signed off on.

Pabau connects to the Claim.MD clearinghouse, which submits CMS-1500 and 837P claims electronically to thousands of US payers. Validation before submission checks the payer and administrative data on the claim, such as membership numbers and authorization codes. Code and modifier selection stays with your coder. Real-time eligibility verification runs before the appointment, so a coverage problem surfaces then rather than as a denial 30 days later.

Pabau also processes electronic remittance advice, known as ERA. It posts 835 payment files against outstanding claims automatically. Billing staff can then see where every 73552 claim stands without working through a stack of EOBs. Secondary claims, corrected claims, and appeals tied to CARC denial reasons run through the same clearinghouse connection.

Streamline your radiology billing workflow

Pabau connects your clinical records to claim submission, so a femur imaging claim leaves the practice with its modifiers and diagnosis attached. See how electronic submission, eligibility checks, and remittance posting work in one system.

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Conclusion

Three checks decide whether a 73552 claim pays. The report has to document two or more views. The modifier has to match who owns the equipment. The diagnosis has to match the indication on the order.

Work from the report rather than the order and the undercoding problem largely disappears. A quarterly look at your 73551-to-73552 ratio will tell you whether charge capture is doing that job. If the ratio looks wrong, the answer is usually a prompt at the point of charge entry rather than another coder training session.

Book a demo to see how Pabau takes a femur imaging claim from the signed report through to a posted payment.

Continue your research

Want to understand how clearinghouse submissions work for musculoskeletal codes? Medical claims clearinghouse guide covers how 837P electronic claims reach payers and what happens when they don’t.

Dealing with 73552 denials and unsure how to respond? Denial codes in medical billing explains CARC and RARC codes and how to build an effective appeal.

Need to verify insurance coverage before the imaging appointment? Insurance eligibility verification outlines the real-time check process that reduces radiology claim rejections at source.

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