CPT Code 72040, cpt 72040, 72040 cpt code

CPT 72040 | Description, Procedure, Billing Guidelines & Reimbursement

CPT code 72040 bills for the service when a physician performs a radiologic examination of the patient’s neck vertebrae. The examination is performed with two or three view X-rays.

1. Description

The 72040 CPT code is officially defined by CPT as: “Radiologic examination, spine, cervical; 2 or 3 views.”

2. Procedure

For the technical component of the X-ray service, as described by CPT 72040, a technician correctly positions the patient and operates the X-ray machine to take two or three different views of the neck. 

Typical views include an:

  • AP view (front to back);
  • accurate lateral view (consisting of all seven cervical vertebrae and the C7–T1 junction from the side); and
  • open–mouth odontoid view. 

For the professional component of this code, a physician interprets the X-ray views and provides a formal written report of the findings.

3. Billing Guidelines

Modifier 26 and the professional component should be appended to CPT 72040 if you are billing only the physician’s interpretation of this service.

Append modifier TC to CPT code 72040 if you report the technical component alone.

Because the hospital’s portion could be inherently technical, the policy of payers can exempt hospitals from reporting modifier TC.

You are not allowed to report CPT 72040 with a technical and/or professional modifier when you report a global service in which one provider renders both components.

4. Reimbursement

Three units can be billed on the same service date, and three units are allowed for documentation to prove the medical necessity of the 72040 CPT code procedure. Below are the costs and RUVs when CPT 72040 is billed with modifier 26, modifier TC or a global modifier.

4.1 CPT 72040 With Modifier 26

Below are the costs and RUVs rates for CPT 72040 if reported with the 26 modifier.

CostsRUVs
Facility$11.900.34388
Non-Facility$11.900.34388
OPPS Global$11.900.34388

4.2 CPT 72040 With Modifier TC

Below are the costs and RUVs rates for CPT 72040 if reported with the TC modifier.

CostsRUVs
Facility$34.821.00632
Non-Facility$34.821.00632
OPPS Global$96.75 2.79571

4.3 CPT 72040 With A Global Modifier

Below are the costs and RUVs rates for CPT 72040 if reported with a global modifier.

CostsRUVs
Facility$46.731.35020
Non-Facility$40.801.17903
OPPS Global$108.653.13959

5. Resources

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=54953&ver=49&

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=53252&ver=158

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