Summary & Overview
CPT 72197: MRI of Pelvis Without and With Contrast
CPT code 72197 denotes magnetic resonance imaging of the pelvis performed both without and with contrast material in a single encounter. This combined MRI study is clinically important for comprehensive evaluation of pelvic organs, soft tissues, and vascularized lesions where contrast-enhanced sequences improve lesion detection and characterization. Nationally, it is a commonly billed advanced imaging procedure across outpatient imaging centers and hospital outpatient departments, and it factors into utilization, prior authorization, and imaging guidelines discussions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for using combined non-contrast and contrast-enhanced pelvic MRI, typical sites of service, and the common modifiers used with this service. The publication also presents benchmarking and reimbursement context where available, summaries of relevant policy updates affecting advanced imaging coverage, and operational considerations for billing and claims submission. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 72197 describes a diagnostic magnetic resonance imaging (MRI) of the pelvis performed both without contrast and with contrast injection during the same session. This combined MRI technique includes non-contrast imaging sequences followed by contrast-enhanced sequences to assess pelvic anatomy and pathology.
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Service type: Diagnostic imaging, MRI (pelvis) with and without contrast
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Typical site of service: Outpatient imaging center or hospital outpatient department; may also be performed in an ambulatory surgery center when clinically indicated
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old female presenting with persistent pelvic pain and abnormal uterine bleeding after an inconclusive ultrasound. The referring gynecologist orders a diagnostic magnetic resonance imaging study of the pelvis performed both without and with IV contrast to evaluate for adenomyosis, leiomyomas (fibroids), endometrial pathology, or pelvic masses. The patient checks in at an outpatient imaging center or hospital radiology department. Screening for MRI safety and IV contrast contraindications (renal function, prior contrast reactions) is completed by nursing staff. The MRI technologist acquires multiplanar pelvic sequences without contrast, then the radiologist or supervising physician approves IV gadolinium administration. Post-contrast sequences are obtained and the interpreting radiologist reviews multiplanar images, generates a signed report, and communicates urgent findings to the referring provider. Typical site of service is an outpatient imaging center or hospital radiology department. Service type: diagnostic imaging (MRI) with and without contrast.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the interpreting physician's professional component separate from the facility technical component. |
TC |