CPT 72195 Pelvic MRI — Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 72195: Pelvic MRI, Without Contrast

CPT code 72195 represents a non-contrast magnetic resonance imaging (MRI) study of the pelvis. As a commonly used diagnostic imaging code, it underpins evaluation of pelvic organs, musculoskeletal structures, and soft tissues when contrast administration is not indicated or contraindicated. Nationally, pelvic MRI without contrast is integral to diagnostic pathways in oncology, musculoskeletal medicine, gynecology, and urology, and it affects imaging utilization, prior authorization workflows, and facility billing practices.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how CPT code 72195 is categorized, common service settings, and the clinical contexts in which non-contrast pelvic MRI is typically used. The publication also summarizes benchmark topics relevant to payers and facilities, such as utilization patterns, authorization considerations, and coding specificity.

This summary is intended for national audiences including payers, health system administrators, and revenue cycle professionals. It focuses on the code definition, service implications, and what stakeholders should expect when managing claims and clinical workflows tied to CPT code 72195. Specific state-level variations and proprietary payer policy details are not included.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 72195pelvic MRIdiagnostic imagingradiologynon-contrast MRIoutpatient imagingmedical billingimaging utilization

Billing Code Overview

CPT code 72195 describes magnetic resonance imaging (MRI) of the pelvis without contrast material. This procedure captures detailed cross-sectional images of pelvic anatomy using MRI technology without the injection of intravenous contrast.

Service type: Diagnostic imaging — MRI of the pelvis (non-contrast)
Typical site of service: Outpatient imaging center or hospital radiology department

Clinical & Coding Specifications

Clinical Context

A 48-year-old female presents to an outpatient imaging center with chronic pelvic pain and suspected pelvic mass on prior ultrasound. The referring gynecologist documents progressive pelvic fullness, abnormal uterine bleeding, and an adnexal mass palpated on exam. The patient is scheduled for a diagnostic magnetic resonance imaging study of the pelvis without contrast to further characterize pelvic anatomy, evaluate uterine and adnexal structures, and assess for fibroids, endometriosis, or ovarian lesions. The typical clinical workflow includes pre-procedure verification of the exam order and indication, screening for MRI safety (implants, pacemakers, pregnancy), patient consent and education about the non-contrast exam, removal of metal objects, IV access only if needed for potential future contrast (not used for this code), positioning supine in the MRI coil, execution of pelvic MRI sequences (T1, T2, diffusion-weighted imaging, and others as indicated), technologist acquisition and image quality checks, and post-procedure image interpretation by a radiologist who issues a diagnostic report to the referring provider. Typical sites of service are outpatient imaging centers, hospital outpatient departments, and ambulatory surgery centers when combined with other services. Service type: Diagnostic imaging (MRI) — pelvis, without contrast (72195).

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component

Related Codes

CPT-72050-CERVICAL-SPINE-XRAY-4-5-VIEWS

CPT 72050: Cervical Spine X‑ray, Four to Five Views

CPT-72082-THORACIC-LUMBAR-SPINE-RADIOGRAPHY-SCOLIOSIS-EVALUATION

CPT 72082: Thoracic and Lumbar Spine Radiography for Scoliosis Evaluation

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

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

CPT-72020-SINGLE-VIEW-SPINE-RADIOGRAPH

CPT 72020: Single-View Radiograph of Specific Spine Level

CPT-72120-LUMBOSACRAL-SPINE-BENDING-VIEWS-RADIOGRAPH

CPT 72120: Lumbosacral Spine Radiographs, Flexion/Extension Views

CPT-72125-CT-CERVICAL-SPINE-WITHOUT-CONTRAST

CPT 72125: CT Cervical Spine Without Contrast

CPT-72197-MRI-PELVIS-WITH-AND-WITHOUT-CONTRAST

CPT 72197: MRI of Pelvis Without and With Contrast

CPT-72295-DISCOGRAM-IMAGING-SUPERVISION-INTERPRETATION

CPT 72295: Imaging Supervision and Interpretation for Lumbar Discogram

CPT-72040-CERVICAL-SPINE-XRAY-2-3-VIEWS

CPT 72040: Cervical Spine X‑Ray, 2–3 Views

CPT-72255-THORACIC-SPINE-MYELOGRAM-IMAGING-SUPERVISION-INTERPRETATION

CPT 72255: Thoracic Spine Myelogram Imaging Supervision and Interpretation

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Taxonomy Code	Specialty	Notes
207Q00000X	Diagnostic Radiology	Radiologists interpret pelvic MRI studies and report findings.
208000000X	Radiology (General)	Imaging specialists who perform and supervise MRI imaging studies.
261QP2300X	Gynecology	Gynecologists commonly order pelvic MRI to evaluate uterine and adnexal pathology.
2084P0800X	Neuroradiology (if pelvic nerve evaluation)	Subspecialists may be involved when pelvic neurogenic pain or nerve evaluation is needed.
207K00000X	Interventional Radiology	May perform image-guided procedures informed by MRI findings; not typically performing the MRI itself.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N80.9`	Endometriosis, site unspecified	MRI pelvis evaluates deep infiltrating endometriosis and extent of disease not well seen on ultrasound.
`N84.1`	Polyp of uterus	MRI can help characterize uterine lesions such as polyps versus submucosal fibroids.
`D25.9`	Leiomyoma of uterus, unspecified	MRI characterizes fibroid number, size, and location for preoperative planning.
`N83.2`	Torsion of ovary, ovarian pedicle	MRI may be used when ultrasound is inconclusive to assess ovarian viability and torsion.
`N85.1`	Polyp of cervix uteri	MRI assists in evaluating cervical masses and local extension when clinical concern exists.
`C56.9`	Malignant neoplasm of ovary, unspecified	MRI helps characterize adnexal masses and assess local spread as part of staging and surgical planning.
`R10.2`	Pelvic and perineal pain	MRI is used in the workup of chronic pelvic pain when etiology is unclear after initial evaluation.
`N91.2`	Secondary amenorrhea	MRI may be used to evaluate structural causes when indicated in gynecologic workup.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`72197`	MRI pelvis with contrast material(s)	Performed when intravenous contrast is required to further characterize a lesion identified on the non-contrast study; may follow `72195` if indicated.
`74177`	MRI abdomen and pelvis with contrast	Used when clinical indication requires combined abdomen and pelvis imaging with contrast for broader evaluation beyond pelvis alone.
`77021`	Magnetic resonance guidance for needle placement	May be used when MRI findings necessitate MR-guided intervention or biopsy in the pelvic region.
`76700`	Ultrasound, abdominal, real time including image documentation; complete	Often used as initial imaging; ultrasound findings commonly prompt pelvic MRI for problem-solving.
`72193`	MRI pelvis, without and with contrast	Alternative code when both non-contrast and contrast sequences are performed in the same session; if contrast is added, selection of the correct combined code is required.