Imaging · Spine

Thoracic spine CT performed with contrast, given by vein or into the spinal canal, commonly as part of a CT myelogram.

3 sources ↓

Medicare: $169.34
Work RVU: 1.19
Global, days
Region: Spine

Drawn from CMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 3 cited references ↓

Contrast route (intrathecal or IV) and agent
Reason MRI was not suitable
Regions scanned, matched to the codes billed
Signed report with cord and canal findings
Authorization for the with-contrast study

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

26 Professional component TC Modifier

What this code covers

Source · Editorial summary grounded in 3 cited references ↓

72129 is thoracic spine CT with contrast. In spine practice it is most often the CT half of a thoracic or full-length CT myelogram, where contrast is injected into the spinal canal and the patient is scanned afterward. It is used when MRI is contraindicated or unreadable from hardware.

Thoracic disc herniation, cord compression from tumor, and stenosis above an old fusion are typical reasons. If the myelogram covers multiple regions, each CT region scanned is billed with its own with-contrast code.

The injection is reported separately. If the injection only supports the CT and no myelogram films are read, 62284 applies. If one physician does the full myelogram with fluoroscopic images, the combined code replaces it: 62303 for thoracic, 62305 when two or more regions are covered. Contrast supply goes on its own line in the office setting. Denials come from authorizations that list the non-contrast code, missing documentation of why MRI was not used, and claims that bill a single region when the report clearly covers more.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (1.19) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.07) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.19
Practice expense RVU	3.79
Malpractice RVU	0.09
Total RVU	5.07
Medicare national rate	$169.34
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$169.34
HOPD (APC 5571) Hospital outpatient department	$179.20

Common denial reasons

The recurring reasons claims for CPT 72129 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Authorization for 72128 instead of 72129
62284 billed with a combined myelography code
No documented contraindication to MRI
Region billed does not match report
Contrast billed without matching HCPCS supply code

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 3 cited references ↓

01How do I bill a CT myelogram covering thoracic and lumbar spine?

Bill 72129 and 72132 for the CT regions, plus the appropriate injection or combined myelography code. Each region scanned is reported separately.

02Is 72129 used for intrathecal contrast?

Yes. CPT treats intrathecal contrast as contrast, so CT after myelography uses the with-contrast code.

03Does Medicare require a reason MRI was not done?

We are not aware of a national Medicare rule on this. Reviewers still expect the note to explain why CT myelography was chosen, and many commercial policies ask for it directly.