Summary & Overview

CPT 72157: Thoracic Spine MRI, Without and With Contrast

CPT code 72157 represents MRI of the thoracic spinal canal and contents performed both without and with intravenous contrast. This combined non-contrast and contrast-enhanced MRI is used to evaluate thoracic spinal cord pathology, intradural and extradural lesions, nerve root abnormalities, postoperative changes, infection, inflammation, and neoplasm. Nationally, CPT 72157 matters because it is a commonly used advanced imaging study that influences diagnostic pathways for midline back pain, neurologic deficit, and suspected spinal disease.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview, guidance on typical sites of service and common modifiers (listed elsewhere), and context for how this service fits into diagnostic workflows for thoracic spine conditions. The publication provides benchmarks where available, notes on coverage considerations, and comparisons to related imaging codes for thoracic and adjacent spinal levels.

This summary is intended for a national audience of clinical administrators, coding professionals, and policy analysts seeking a clear reference for CPT code 72157 — its clinical purpose, service setting, and relevance to payer coverage and billing operations.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 72157thoracic spine MRIdiagnostic imagingmagnetic resonance imagingspine imagingcontrast-enhanced MRIradiology codingimaging services

Billing Code Overview

CPT code 72157 describes magnetic resonance imaging (MRI) of the thoracic spinal canal and contents performed both without and with contrast. The procedure includes acquisition of images before contrast administration and repeat imaging after intravenous contrast to evaluate the thoracic spine, spinal canal, spinal cord, nerve roots, and paraspinal soft tissues.

Service type: Diagnostic imaging (MRI with and without contrast)
Typical site of service: Hospital outpatient imaging center or freestanding radiology/imaging facility

Clinical & Coding Specifications

Clinical Context

A 54-year-old patient presents to the outpatient imaging center with progressive mid-back pain, unilateral lower-extremity paresthesia, and new-onset gait instability. Neurologic exam reveals diminished lower-extremity reflexes and localized thoracic tenderness. The referring spine specialist orders an MRI of the thoracic spine with and without contrast to evaluate for compressive myelopathy, suspected intradural or intramedullary lesion, infection, neoplasm, or postoperative scar. The imaging appointment is scheduled at an ambulatory radiology facility; the patient completes screening for MRI safety (implants, claustrophobia, renal function for gadolinium use). The technologist performs the non-contrast sequences first (T1, T2, STIR, sagittal/axial) followed by intravenous administration of gadolinium-based contrast and acquisition of post-contrast sequences. The radiologist interprets the combined studies, documents comparison to prior exams if available, and issues a final report to the referring physician for management decisions such as surgical planning, biopsy, or conservative care adjustments.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the interpreting radiologist's professional component separate from the technical facility charge.
`TC`	Technical component	Use when billing only the technical component (facility, technologist, equipment) and not the physician interpretation.
`59`	Distinct procedural service	Use when another distinct, unrelated procedure is performed on the same day and documentation supports separate service.
`76`	Repeat procedure by same physician	Use when the same MRI study is repeated later the same day by the same physician.
`77`	Repeat procedure by another physician	Use when the MRI is repeated by a different physician on the same day.
`52`	Reduced services	Use when the study is partially reduced or not fully performed and documentation supports reduced work.
`53`	Discontinued procedure	Use when the MRI is started but discontinued due to patient instability, claustrophobia, or safety concerns.
`76`	Repeat procedure by same physician	Use when the same MRI study is repeated later the same day by the same physician.
`76`	Repeat procedure by same physician	Use when the same MRI study is repeated later the same day by the same physician.
`75`	(Not in provided list)	Data not available in the input.

Taxonomy Code	Specialty	Notes
`2084P0204X`	Diagnostic Radiology	Most common specialty performing MRI interpretation and procedural oversight.
`2084P0800X`	Neuroradiology	Subspecialty often interpreting complex spinal cord and intradural pathologies.
`207R00000X`	Physical Medicine & Rehabilitation	Referring specialty for functional spine evaluations and non-operative management planning.
`207XS0102X`	Orthopedic Spine Surgery	Referring and ordering specialty for surgical planning based on MRI findings.
`207L00000X`	Neurology	Referring specialty when neurologic deficits or neurodegenerative processes are suspected.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M54.6`	Pain in thoracic spine	Common presenting complaint prompting thoracic spine MRI to evaluate structural causes.
`G95.19`	Other specified diseases of spinal cord	Used when suspected myelopathy or intrinsic cord disease is being evaluated with MRI.
`G83.4`	Cauda equina syndrome (not thoracic but included for radiculopathy context)	MRI differentiates compressive lesions causing severe neurologic deficits; variant codes used per level.
`C79.49`	Secondary malignant neoplasm of other parts of nervous system	Thoracic MRI assesses metastatic disease to the spinal canal or cord.
`M48.06`	Spinal stenosis, thoracic region	MRI documents degree and location of stenosis for surgical planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`72156`	Magnetic resonance imaging, thoracic; without contrast material	Performed when contrast is contraindicated or an initial non-contrast exam is ordered; `72157` includes both non-contrast and contrast sequences.
`72158`	Magnetic resonance imaging, thoracic; with contrast material(s)	Represents only the contrast-enhanced portion; often reported when a limited post-contrast study is separately performed.
`77021`	Magnetic resonance guidance for needle placement (CT and MRI), imaging supervision and interpretation	Used when MRI-guided spine biopsy or intervention is performed following MRI diagnosis.
`72195`	Radiologic examination, spine, MRI, including spinal cord, without and with contrast, cervical or thoracic or lumbar; may be used for complex protocols	Used in some facility coding contexts for combined spine regions or extended protocols; relates to comprehensive spine imaging.
`71260`	CT scan, thorax; with contrast material	Occasionally obtained in parallel for osseous or thoracic pathology correlation; not a substitute for spinal MRI but complementary in workflow.