CPT 72131 CT Lumbar Spine Reimbursement | OpenPayer

Summary & Overview

CPT 72131: CT Lumbar Spine, Without Contrast

CPT code 72131 represents a non-contrast computed tomography (CT) examination of the lumbar spine. As a common diagnostic imaging modality, this code is used to evaluate lumbar vertebrae and adjacent structures for trauma, degenerative disease, infection, and other conditions where cross-sectional bone and soft-tissue detail is needed without contrast enhancement. Nationally, CT of the lumbar spine is an important tool in acute and chronic spine evaluation and factors into utilization, coding, and payment policies across major payers.

Key payers in standard analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 72131, typical sites of service, common billing considerations, and the payer landscape. The publication also summarizes benchmarks and reimbursement patterns where available, notes relevant policy updates affecting non-contrast lumbar CT utilization, and outlines how this service fits into broader diagnostic imaging pathways. Data not available in the input is identified explicitly where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare72131CPTCT lumbar spinediagnostic imagingradiologynon-contrast CTimaging utilizationoutpatient imaging

Billing Code Overview

CPT code 72131 describes a computed tomography (CT) examination of the lumbar spine without contrast. This diagnostic imaging procedure acquires cross-sectional images of the lumbar vertebrae and surrounding soft tissues using CT technology without intravenous or oral contrast agents.

Service type: Diagnostic imaging (CT scan of the lumbar spine, non-contrast)
Typical site of service: Outpatient imaging center, hospital radiology department, or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A typical patient is a 52-year-old presenting to an outpatient radiology center or hospital imaging department with a 6-week history of progressive low back pain radiating to the left posterior thigh with associated numbness. Conservative care (NSAIDs, activity modification, physical therapy) has not improved symptoms. The referring clinician documents focal lumbar tenderness, positive straight leg raise on the affected side, and neurologic deficits suggesting nerve root compression. The provider orders a computed tomography of the lumbar spine without contrast (72131) to evaluate bony anatomy, facet arthropathy, disc calcification, or suspected osseous pathology when MRI is contraindicated or unavailable.

Workflow: The patient arrives at the imaging facility (typical site of service: outpatient radiology center or hospital outpatient department). Registration and pre-procedure screening are completed for contraindications. The CT technologist reviews the order, confirms laterality and clinical indication, performs patient positioning and acquisition of non-contrast axial CT images through the lumbar spine with multiplanar reconstructions. Images are transmitted to the interpreting radiologist (often a diagnostic radiologist with musculoskeletal experience) who reviews images, generates a report documenting findings (e.g., vertebral fractures, degenerative changes, spinal stenosis), and provides impression for the referring clinician. Billing uses CPT code 72131 for the technical and professional components as appropriate, with modifier reporting where applicable.

Coding Specifications

Modifier	Description	When to Use

CPT 72100: Lumbosacral Spine X‑Ray, 2–3 Views

CPT-72196-MRI-PELVIS-WITH-CONTRAST

CPT 72196: MRI Pelvis with Contrast

CPT-72126-CT-CERVICAL-SPINE-WITH-CONTRAST

CPT 72126: CT Cervical Spine With Contrast

CPT-72270-MYELOGRAM-IMAGING-SUPERVISION-INTERPRETATION-MULTI-REGION

CPT 72270: Myelogram Imaging Supervision and Interpretation, Two or More Regions

CPT-72147-MRI-THORACIC-SPINE-WITH-CONTRAST

CPT 72147: MRI Thoracic Spine With Contrast

CPT-72129-THORACIC-SPINE-CT-WITH-CONTRAST

CPT 72129: CT Thoracic Spine with Contrast

CPT-72132-CT-LUMBAR-SPINE-WITH-CONTRAST

CPT 72132: CT Lumbar Spine With Contrast

CPT-72146-THORACIC-SPINE-MRI-WITHOUT-CONTRAST

CPT 72146: Thoracic Spine MRI, Without Contrast

CPT-72128-THORACIC-SPINE-CT-NON-CONTRAST

CPT 72128: CT Thoracic Spine without Contrast

CPT-72220-SACRUM-COCCYX-XRAY-TWO-VIEWS

CPT 72220: X-ray of Sacrum and Coccyx, Minimum Two Views

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Taxonomy Code	Specialty	Notes
`2085R0200X`	Diagnostic Radiology	Radiologists who interpret CT lumbar spine studies.
`207T00000X`	Radiology—Diagnostic	General diagnostic radiology specialists performing and supervising CT imaging.
`261QM0800X`	Physical Medicine & Rehabilitation	Referring specialists who commonly order lumbar CT when MRI is contraindicated.
`207L00000X`	Neurological Surgery	Referring and interpreting surgeons evaluating bony pathology or preoperative planning.
`207X00000X`	Orthopaedic Surgery	Referring surgeons assessing degenerative or traumatic lumbar conditions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M51.26`	Other intervertebral disc displacement, lumbar region	CT can evaluate disc-related bony changes, calcified herniations, or assist when MRI is contraindicated.
`M48.06`	Spinal stenosis, lumbar region	CT provides bony detail to assess central or foraminal stenosis from osteophytes or facet hypertrophy.
`S32.010A`	Unspecified fracture of lumbar vertebra, initial encounter for closed fracture	CT is used to characterize vertebral fractures and alignment for acute trauma.
`M54.16`	Radiculopathy, lumbar region	CT may be used to identify osseous causes of nerve root compression when MRI is not possible.
`M47.816`	Spondylosis without myelopathy or radiculopathy, lumbar region	CT demonstrates osteophytes, facet arthropathy, and degenerative changes contributing to symptoms.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`72132`	Computed tomography, lumbar spine; with contrast material(s)	Performed when intravenous contrast is required to evaluate epidural enhancement, infection, or neoplasm following or instead of non-contrast study.
`72133`	Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections	Used when both non-contrast and contrast-enhanced phases are clinically indicated in the same encounter.
`72148`	Magnetic resonance imaging, spinal canal and contents, lumbar; without contrast material	Alternative imaging modality often ordered instead of CT when soft-tissue detail (disc, nerve root, cord) is needed and MRI is not contraindicated.
`72131`	Computed tomography, lumbar spine; without contrast material	Primary procedure described; used for bony detail and evaluation when MRI not feasible.
`77012`	Computed tomography guidance for abscess/tissue drainage (if applicable)	May be performed afterward if CT identifies a fluid collection or abscess requiring image-guided drainage; represents an interventional follow-up.

`26`	Professional component	When reporting only the interpreting physician’s service separate from the technical component.
`TC`	Technical component	When reporting only the facility/technical portion of the CT scan.
`59`	Distinct procedural service	When a separate, distinct CT study or another unrelated procedure is performed the same day and documentation supports distinct service.
`76`	Repeat procedure by same physician	When the same CT scan is repeated after an initial complete study by the same provider.
`77`	Repeat procedure by another physician	When the same CT scan is repeated by a different provider.
`52`	Reduced services	When the CT is partially reduced or incomplete (e.g., limited study due to patient intolerance).
`53`	Discontinued procedure	When the CT is started but terminated due to patient event or safety concerns before completion.
`25`	Significant, separately identifiable E/M service	When a separate evaluation and management visit is performed on the same day as the CT and medically necessary documentation supports it.
`91`	Repeat clinical diagnostic laboratory test	Rarely used for imaging; included when institutional workflows require `91` for repeated diagnostic tests per payer rules — typically not applicable to CT imaging.
`59`	(listed above)	(duplicate entry removed in table)
`76`	(listed above)	(duplicate entry removed in table)

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