MRI of an upper extremity region other than a joint, done without contrast, such as the forearm or upper arm, for masses, muscle injury, or soft tissue problems.
- Medicare
- $303.28
- Work RVU
- 1.32
- Global, days
- Region
- Multi-region
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Order naming the region (forearm, upper arm) and the clinical question
- Exam findings and conservative care tried, when the payer requires them
- Prior authorization matching 73218
- Laterality
- Signed interpretation with findings and impression
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 ↓
Use 73218 for upper extremity MRI when the target is not a joint. Think forearm or humeral shaft: a soft tissue mass, a muscle tear, a distal biceps injury imaged through the forearm, or a stress lesion in the shaft of a bone. If the study is centered on the shoulder, elbow, or wrist joint, the code is 73221 instead. This is the most common mix-up with 73218, and payers with radiology benefit managers will catch it because the authorization usually names the joint code.
In an ortho practice, 73218 orders come from the sports and hand side as much as the general side. Distal biceps tears are a frequent example. Some sites code these as elbow joint MRI, others as non-joint upper extremity. Follow the radiology report: if the protocol was an elbow MRI, use the joint code.
There is no contrast in 73218. With contrast only is 73219, and without followed by with is 73220. Bill the professional read with modifier 26 when the scan is done in a hospital or imaging center, and include laterality.
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 (1.32) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.08) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.32 |
| Practice expense RVU | 7.66 |
| Malpractice RVU | 0.1 |
| Total RVU | 9.08 |
| Medicare national rate | $303.28 |
| 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 | $303.28 |
HOPD (APC 5523) Hospital outpatient department | $243.77 |
Common denial reasons
The recurring reasons claims for CPT 73218 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Study was a joint MRI and should have been 73221
- Authorization issued for a different MRI code
- Insufficient clinical history for the radiology benefit manager
- Missing laterality or 26/TC modifiers
- Duplicate claim for the same region from both the reading physician and the imaging center globally
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01When do I use 73218 instead of 73221?
02Is a distal biceps MRI coded as 73218 or 73221?
03What code is MRI forearm with contrast?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes document the exam findings, symptom duration, and treatment tried before the MRI order, the details radiology benefit managers ask for during authorization.
See how Mira captures CPT 73218 documentation