Computed tomography of the lumbar spine without contrast, used for fractures, bony stenosis, spondylolysis, and checking fusion or screw placement.
- Medicare
- $129.93
- Work RVU
- 0.98
- Global, days
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Duration and type of conservative care tried
- Red flag findings, if imaging is earlier than six weeks
- Neurologic exam with dermatomal findings
- Postoperative question when imaging after fusion
- Signed report and authorization number
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
72131 is non-contrast lumbar spine CT. Spine surgeons rely on it for pars defects, bony foraminal stenosis, fracture assessment, and postoperative questions: is the fusion solid, did a screw breach, is there lucency around hardware. It is also used when MRI is contraindicated, though it shows discs and nerves less well.
For low back pain, payer rules are strict. Most commercial and radiology benefit manager policies expect about six weeks of documented conservative care before advanced imaging, unless there are red flags such as progressive weakness, cauda equina symptoms, cancer history, infection risk, or trauma. The note needs to show what was tried: PT dates, medications, injections, activity changes.
If CT is done with intrathecal contrast after a myelogram, bill 72132 instead. Reformats are included. Only bill 3D rendering when it is separately documented and meets the code requirements.
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 (0.98) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.89) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.98 |
| Practice expense RVU | 2.84 |
| Malpractice RVU | 0.07 |
| Total RVU | 3.89 |
| Medicare national rate | $129.93 |
| 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 | $129.93 |
HOPD (APC 5522) Hospital outpatient department | $106.81 |
Common denial reasons
The recurring reasons claims for CPT 72131 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Less than six weeks of conservative care with no red flags
- No prior authorization
- Diagnosis is nonspecific low back pain
- Contrast was intrathecal but non-contrast code billed
- Repeat study too soon after prior imaging
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How much conservative treatment is needed before a lumbar CT?
02Is lumbar CT after fusion covered?
03What code is used for lumbar CT after a myelogram?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe pulls the conservative care history, neuro findings, and any red flags into the note, which is the exact record a lumbar imaging reviewer asks for.
See how Mira captures CPT 72131 documentation