CPT code 73030

(2022) CPT Code 73030 Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 73030 bills for service when the physician performs a radiologic examination of the whole shoulder with a minimum of two views.

CPT Code 73030 Description

The Following are the reasons why the physician performs CPT code 73030:

  • Arthritis.
  • Benign bone tumors.
  • Bone cancer.
  • Broken bones (shoulder fractures).
  • Bursitis.
  • Dislocated shoulder.
  • Problems with the alignment of the shoulder joint.
  • Rotator cuff calcifications (buildup of calcium on the rotator cuff tendon).
  • Rotator cuff tears.

The physician performs radiologic imaging of the shoulder, which transfers electromagnetic wave radiation through the patient’s body. These waves generate a scan on X-ray film or a digital sensor. 

The physician may take a broad series of shoulder images to detect disformity. These images show white bones on x-ray as radiation cannot emit through the bones. The muscles or other tissue may appear black or gray because some waves can pass through.

The physician may need other studies as well, in addition to should x-ray, to determine the root cause of the problem, such as Magnetic resonance imaging (MRI), Ultrasound, CT (computed tomography) scan, 

The shoulder comprises of following joints, and a physician may perform an x-ray to view these joints:

  • Ball-and-socket joint
  • The scapula (shoulder blade) that connects to the humerus
  • Humerus (upper arm bone)
  • Acromion (a piece of bone that projects off the scapula)

The clavicle (collarbone) relates to the acromion Coracoid process (a hook-shaped part of the bone that projects off the scapula).

The nerves, cartilage, muscles, and tendons may not be visible on an x-ray but are significant in identifying the position and shape of your bones when performed by the physician.

The patient is supine with the arm extended to a 90-degree angle from the body and the physician rotates externally while the head is turned to face opposite the affected side. The physician takes the film of the shoulder. CPT code 73020 is appropriate to report when one view of the shoulder performs by the physician. In contrast, 73030 CPT code bills for a minimum of two views.

73030 cpt code

CPT Code 73030 Reimbursement

A maximum of one unit can be a bill on the same service date of CPT code 73030. In contrast, the Three unit allows when documentation supports the medical necessity of the service.  

The cost and RUVS of CPT code 73030 with modifier 26 are $10.04 and 0.29021 when performed in the facility. In contrast, the reimbursement and RUVS of 73030 CPT code with modifier 26 are $10.04 and 0.29021 when performed in the non-facility. In OPPS global, the cost and RUVS of CPT 73030 with modifier 26 are 10.04 and 0.29021.

The cost and RUVS of CPT 73030 with modifier TC are $30.76 and 0.88882 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 73030 with modifier TC are $30.76 and 0.88882 when performed in the non-facility. In OPPS global, the cost and RUVS of CPT code 73030 with modifier TC are $96.75 and 2.79571.

In OPPS global, the cost and RUVS of CPT 73030 with a global modifier are $106.79 and 3.08592. The cost and RUVS of CPT 73030 with global billing are $40.80 and 1.17903 when performed in the facility. In contrast, the reimbursement and RUVS of 73030 CPT code with global billing are $40.80 and 1.17903 when performed in the non-facility.

CPT Code 73030 Modifiers 

The following are the list modifiers when CPT code 73030 bills:  

  • 22, 23, 26, 50, 52, 53, 58, 59, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, ET, EY, FX, FY, GA, GC, GK, GR, GU, GY, GZ, KX, PT, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS, LT, RT.

The most frequent bill modifiers are 26, TC, 77, 76, 59, or X {E, P, S, U} with 73030.    

Modifier 26 bills to indicate the professional component of services when attached with 73030. It shows that the Physician work as an employee in a hospital and facility, not owning the equipment.  

Modifier TC applicable with CPT code 73030 indicates the Technical component or machinery used in service. It usually bills with Hospital and facility claims.  

CPT 73030 bills globally when physician-owned the office and equipment. Service bills without TC and 26 modifiers. 

 Modifier 76 is applicable with CPT 73030 when a similar service performs by the Same Physician on the same day.   

Modifier 76 is applicable with CPT 73030 when a similar service performs by a different Physician on the same service date. 

Modifier 59 is applicable with CPT 73030 when Distinct service performs by the physician and bundled with another procedure on the same date.   

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with 73030 when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure. 

If physicians believe that Medicare will deny such service, reporting with a GA  modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT code 73030 must apply the GA modifier to that service. 

Modifier 52 is applicable when the physician cannot complete the procedure due to unavoidable circumstances.

CPT Code 73030 Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.   

The following are the most used payable dx codes for CPT code 73030:

M25.511, M25.512, M25.519, M19.011, M19.012, M19.09, M75.21, M75.22, M75.29, M25.411, M25.412, M25.419, C43.60, C43.61, C43.62, M24.411, M24.412, M24.419, etc.

The physician can perform a minimum number of views or more views when needed to complete the study Radiographs are adequately repeated during encounters due to substandard quality. Only 1 unit bills according to the description, only one unit bills if the physician furnishes multiple studies.

The physician may Obtain more films after the initial film review, based on radiologist discretion, order for the test, and change in the patient’s condition.

If the physician uses a second interpretation by requesting a physician (included in E/M service), it is not appropriate to report separately with CPT code 73030.

It is appropriate to report Stress views upper body joint(s) with CPT code (77071) when performing in addition to CPT 73030.

These are unilateral procedures. If performed bilaterally, some payers require that the service be reported twice with modifier 50 appended to the second code. In contrast, others require identification of the service only once with modifier 50 appended. 

Check with individual payers. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image). The Insurance may require LT and RT modifiers for the bilateral procedure.

CPT code 73030 has both a technical and professional component. It is appropriate to attach TC with technical components and 26 with the professional component. 

Submit without a modifier to bill the complete procedure (i.e., professional and technical features). 

HCPCS codes R0070 and R0075 are applicable when the Phyciscan uses transportation of portable x-ray equipment and personnel during the procedure. Check your payer guideline to see if these services are covered. For stress views of the shoulder, see 77071.

Examples

The following are the examples when CPT 73030 bills:

Example 1

Right shoulder

HISTORY: FALL Initial encounter.

IMAGING: Frontal and Y views.

COMPARISON: None

FINDINGS:

Osseous structures and joint spaces are well-maintained. There are minor degenerative changes in the AC joint. No fracture saw by the physician.

IMPRESSION:

No fracture saw in the x-ray.

Reported and Signed by:  XYZ MD

Example 2

Left shoulder

HISTORY: Left shoulder pain, unspecified chronicity

The physician sees a limited range of motion in the Initial shoulder encounter.

IMAGING: Frontal and Y views.

COMPARISON: None

FINDINGS:

Osseous structures and joint spaces are well-maintained. There are no soft tissue calcifications.

No fracture saw.

IMPRESSION:

Normal study.

Reported and Signed by:  XYZ MD

Example 3

HISTORY: chronic persistent right shoulder pain

IMAGING: 4 views of the right shoulder.

COMPARISON: None.

Findings: The bony structures are unremarkable. No fracture or dislocation identifies in the x-ray.

The soft tissues are normal. The visualized lung fields are clear.

IMPRESSION:

Unremarkable views of the right shoulder.

Reported and Signed by:  XYZ, MD

Example 4

Exam: Right shoulder, two views.

INDICATION: Right shoulder pain after an injury.

No comparison.

FINDINGS:

Two views of the right shoulder did reduce by internal rotation of the humerus                              

The bones are osteopenic without a displaced right shoulder fracture. There is no evidence of dislocation.

IMPRESSION:

Limited examination without evidence of a right shoulder fracture.

Example 5

Exam: 2 views of the right shoulder

Indication: Injury, trauma, fall two weeks ago and right shoulder

Comparison: X-ray from 5/6/2022

Findings: The patient is status-post reverse right shoulder arthroplasty.

The hardware appears intact and in the expected position. No acute fracture or dislocation identifies by the physician. The visualized right lung is clear. The hypertrophic changes saw in the right acromioclavicular joint.

Impression:

No acute fracture findings or dislocation of the right shoulder. Status post reverse right shoulder arthroplasty.

Example 5

A 60-year-old female presents with osteoarthritis of the shoulder and has had pain for four days to the office. The pain gets worse with movement and when lying down. The patient took some medication for pain. 

The physical exam revealed swelling in the upper extremity. The physician ordered an X-ray of the shoulder.

 It shows degeneration of the shoulder joints and effusion in both shoulders. The patient also has tendonitis of the shoulder region. The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. 

The physician administers the steroid injection in the joint space for pain management.

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