Radiological supervision and interpretation of a thoracic myelogram when the injection is performed by a separate physician.
- Medicare
- $104.21
- Work RVU
- 0.89
- 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 ↓
- Physician who performed the injection versus interpreter
- Regions imaged
- MRI contraindication or failure
- Contrast and puncture details
- Signed report with cord and canal findings
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 ↓
72255 is supervision and interpretation for a thoracic myelogram. It is only used when the injection is billed by someone else, typically with 62284. When one physician performs the whole procedure, the combined thoracic myelography code replaces both.
Thoracic myelography is uncommon in orthopedic practice. It comes up when a patient with a pacemaker or old spinal hardware needs evaluation of thoracic cord compression, or when a thoracic disc herniation needs to be shown before surgery. CT usually follows and is billed as 72129.
Myelograms covering more than one region need care. If one physician does the whole procedure covering two or more regions, 62305 covers two or more regions. If the injection and interpretation are split, the interpreting physician reports 72270, the supervision code for two or more regions, instead of stacking 72255 with 72240 or 72265. Payers will not accept both the combined code and 72255 for the same procedure. Document why MRI could not answer the question.
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 (0.89) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.12) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.89 |
| Practice expense RVU | 2.17 |
| Malpractice RVU | 0.06 |
| Total RVU | 3.12 |
| Medicare national rate | $104.21 |
| 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 | $104.21 |
HOPD (APC 5573) Hospital outpatient department | $800.90 |
Common denial reasons
The recurring reasons claims for CPT 72255 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Same physician billed injection and 72255 instead of the combined code
- Billed along with a combined myelography code
- Regions billed do not match report
- No reason for myelography over MRI
- Missing authorization
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Who bills 72255?
02How is a thoracic and lumbar myelogram billed by one physician?
03Is 72255 still a valid code?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records the reason MRI cannot be done and the thoracic level in question, so the myelogram order is supported.
See how Mira captures CPT 72255 documentation