Summary & Overview
CPT 72196: MRI Pelvis with Contrast
CPT code 72196 represents magnetic resonance imaging (MRI) of the pelvis performed with intravenous contrast. This diagnostic imaging code is widely used across hospital radiology departments, outpatient imaging centers, and ambulatory settings to evaluate pelvic organs, soft tissues, and vascular structures. Nationally, contrast-enhanced pelvic MRI plays a central role in oncologic staging, assessment of complex pelvic pain, and characterization of indeterminate lesions identified on other imaging modalities.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and service settings tied to the code, plus how common payer coverage patterns and pricing benchmarks typically relate to contrast-enhanced pelvic MRI. The publication outlines typical charges and reimbursement considerations, common modifier usage, and coding relationships relevant to billing and claims processing. Policy updates and payer-specific payment policies that affect utilization and prior authorization practices are summarized to inform billing operations and compliance teams.
This national-level summary is intended to provide clinicians, coding professionals, and revenue cycle staff with a focused reference on the clinical context, billing implications, and payer considerations associated with CPT code 72196.
Billing Code Overview
CPT code 72196 describes magnetic resonance imaging (MRI) of the pelvis performed with contrast. This is a diagnostic radiology procedure that uses MRI technology and intravenous contrast agents to enhance tissue characterization and lesion detection in pelvic structures.
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Service type: Diagnostic imaging (MRI with contrast)
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Typical site of service: Outpatient imaging centers, hospital radiology departments, and ambulatory surgical centers
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Clinical & Coding Specifications
Clinical Context
A 48-year-old female presents with progressive pelvic pain and abnormal uterine bleeding despite medical therapy. The referring gynecologist requests diagnostic imaging to evaluate suspected uterine fibroids, adenomyosis, or adnexal mass. The patient is scheduled for a contrast-enhanced pelvic magnetic resonance imaging study to better characterize soft-tissue structures, delineate lesion vascularity, and guide management decisions. Typical workflow: pre-procedure screening for MRI safety and contrast allergy, intravenous access placement, informed consent, performance of a contrast-enhanced MRI pelvis protocol by a radiology technologist, image interpretation by a radiologist, and generation of a final report to the referring provider. Typical site of service is an outpatient imaging center or hospital radiology department. Service type: diagnostic, cross-sectional imaging with intravenous contrast.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the radiologist interpretation separate from technical imaging. |
TC | Technical component | Use when billing only the imaging equipment/technique portion and not the physician interpretation. |