Summary & Overview
CPT 72170: Radiologic Examination of Pelvis, 1 or 2 Views
CPT code 72170 is a widely utilized billing code for radiologic examination of the pelvis, covering 1 or 2 views. This procedure is a cornerstone in diagnostic radiology, aiding clinicians in evaluating pelvic pain, trauma, and musculoskeletal conditions. The code is relevant across outpatient hospital settings and is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare.
This publication provides a comprehensive overview of CPT 72170, detailing its clinical applications, payer coverage, and associated billing practices. Readers will gain insight into typical use cases, common modifiers such as 26, TC, and 59, and related taxonomies in diagnostic and nuclear radiology. The summary also highlights key ICD-10 diagnoses frequently linked to this code, such as pain in the hip, fractures, osteoarthritis, and pelvic sprains. Additionally, related CPT codes for more extensive or alternative imaging procedures are outlined for context.
Healthcare professionals and policy analysts will find benchmarks, policy updates, and clinical context for CPT 72170, supporting informed decision-making in radiology billing and coding. The information is structured to address national trends and payer requirements, ensuring relevance for a broad audience.
CPT Code Overview
CPT 72170 represents a radiologic examination of the pelvis with 1 or 2 views. This procedure is commonly performed to assess pelvic injuries, pain, or abnormalities and is a fundamental diagnostic tool in radiology. The service type is Radiology, and the typical site of service is an outpatient hospital setting (Place of Service 22). This code is frequently used in clinical practice to provide essential imaging for a variety of pelvic conditions.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with complaints of hip or pelvic pain, following trauma or due to chronic conditions such as osteoarthritis. The clinician orders a radiologic examination of the pelvis with 1 or 2 views to assess for fractures, sprains, or degenerative changes. The radiology team performs the imaging, and the results are interpreted by a diagnostic radiologist. This workflow is typical for evaluating acute injuries or chronic pain in the pelvic region.
Coding Specifications
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Modifiers:
26: Professional Component – Used when only the interpretation of the radiologic images is performed by the physician.TC: Technical Component – Used when only the technical aspect (equipment, staff, etc.) of the radiologic service is provided.59: Distinct Procedural Service – Used to indicate that the procedure is distinct or separate from other services performed on the same day.
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Provider Taxonomies:
Code Specialty Name 2085R0202XDiagnostic Radiology 2085N0700XNuclear Radiology 2085B0100XBody Imaging
These taxonomies represent specialties qualified to perform and interpret pelvic radiologic examinations.
Related Diagnoses
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M25.551: Pain in right hip- Relevant for patients presenting with right hip pain, often prompting pelvic imaging to rule out fracture or degenerative changes.
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M25.552: Pain in left hip- Used for left hip pain, indicating the need for pelvic radiographs to assess for injury or arthritis.
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S32.9XXA: Fracture of unspecified part of lumbar spine and pelvis, initial encounter- Indicates acute trauma, where pelvic imaging is essential to identify fractures.
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M16.10: Unilateral primary osteoarthritis, unspecified hip- Used for patients with suspected osteoarthritis, where imaging helps confirm diagnosis and assess severity.
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S33.5XXA: Sprain of ligaments of pelvis, initial encounter- Relevant for acute pelvic injuries, where radiographs are used to rule out associated fractures or structural damage.
Related CPT Codes
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72190: Radiologic examination, pelvis; complete, minimum of 3 views- Used when a more comprehensive pelvic imaging is required, often for complex cases or when additional detail is needed.
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73502: Radiologic examination, hip, unilateral; 2-3 views- Used when imaging is focused on one hip, typically for localized pain or injury.
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73521: Radiologic examination, hips, bilateral; 2 views- Used when both hips need to be evaluated, such as in cases of bilateral symptoms or conditions.
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73552: Radiologic examination, femur, 2 views- Used when the femur is suspected to be involved, either due to trauma or extension of pelvic pathology.
These codes may be used as alternatives or in conjunction with 72170 depending on the clinical scenario and the area requiring evaluation.
National Reimbursement Benchmarks
Nationally, Medicare's mean rate for CPT code 72170 is $19.47, which is significantly lower than the BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna) commercial average of $27.35. Among commercial payers, Cigna has the highest mean rate at $30.25, while Aetna is the lowest at $25.40.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Cigna shows the widest spread ($37.22 - $19.46 = $17.76), indicating greater variability in rates, while Aetna has the tightest range ($28.57 - $19.23 = $9.34). Medicare's range is $18.00, reflecting substantial variation across its localities.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
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