CPT 72198 Pelvic MRA Reimbursement & Policy

CPT code 72198 represents magnetic resonance angiography (MRA) of the pelvic vasculature, a diagnostic imaging study used to evaluate pelvic arterial and venous anatomy for conditions such as stenosis and aneurysm. This imaging code is relevant nationally because pelvic vascular disease and aneurysmal conditions affect diverse patient populations and frequently require precise noninvasive vascular assessment to guide management decisions. Payment and coverage for advanced imaging remain a focus of payers and policy makers due to utilization, appropriateness, and evolving contrast-enhanced techniques.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for pelvic MRA, typical service settings, and the primary considerations that affect coding and billing. The publication summarizes benchmark topics including common billing practice for diagnostic pelvic MRA, reimbursement and coverage trends among major payers, and policy issues that influence use of contrast-enhanced vascular MRI.

This document provides clinical context, coding identification, and an outline of the payer landscape to support coding staff, radiology administrators, and policy analysts in understanding where CPT code 72198 fits within diagnostic vascular imaging services. Data not available in the input is noted where relevant.

Billing Code Overview

CPT code 72198 describes magnetic resonance angiography (MRA) of the pelvic blood vessels, performed to evaluate for vascular abnormalities such as stenosis or aneurysm. The procedure may be performed with or without intravenous contrast depending on clinical indication.

Service Type: Diagnostic radiology — vascular imaging (MRA)

Typical Site of Service: Outpatient imaging center or hospital radiology department

Clinical Context

A 68-year-old patient with a history of peripheral artery disease and new-onset claudication is referred for vascular imaging of the pelvis. The patient reports progressive pain in the buttock and thigh with exertion, and the vascular specialist orders noninvasive imaging to evaluate for pelvic arterial stenosis or aneurysm. The clinical workflow includes pre-procedure screening for renal function and contrast allergy, informed consent discussing potential use of gadolinium-based contrast, IV placement if contrast is planned, performance of a pelvic magnetic resonance angiography (CPT 72198) in the MRI suite by a radiology team, image post-processing and interpretation by a board-certified radiologist, and communication of findings to the referring vascular surgeon or interventional radiologist for treatment planning. Typical sites of service are an outpatient imaging center or hospital radiology department. The service type is diagnostic imaging (magnetic resonance angiography of pelvic vessels).

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the interpreting physician’s service separate from technical imaging.
`TC`

Taxonomy Code	Specialty	Notes
207R00000X	Radiology	Diagnostic imaging and interpretation of MR angiography.
2084P0800X	Vascular Surgery	Referral source and procedural follow-up for pelvic vascular disease.
207K00000X	Diagnostic Radiology	Interpreting physician performing cross-sectional vascular imaging.
207T00000X	Interventional Radiology	May perform follow-up catheter-based angiography or interventions based on MRA findings.
207L00000X	Neuroradiology (optional)	If pelvic venous congestion or atypical pelvic vascular anatomy requires subspecialty input.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.209`	Unspecified atherosclerosis of native arteries of the extremities, unspecified extremity	Atherosclerotic disease causing pelvic inflow stenosis and claudication prompting pelvic MRA.
`I72.3`	Aneurysm of artery of lower extremity	Pelvic MRA detects aneurysmal dilatation involving iliac or pelvic arteries.
`I80.2`	Phlebitis and thrombophlebitis of other deep vessels of lower extremities	Pelvic venous thrombosis may be evaluated with MR venography sequences during the MRA study.
`N94.89`	Other specified conditions associated with female genital organs and menstrual cycle	Pelvic vascular anomalies or venous congestion contributing to pelvic pain may be assessed with pelvic vascular imaging.
`R52`	Pain, not elsewhere classified	Unexplained pelvic or buttock pain with suspected vascular etiology evaluated with MRA.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`72195`	Radiologic examination, pelvis; single view	May be performed prior to MRA for basic bony or gross pelvic assessment, rarely used in vascular workup.
`73721`	Magnetic resonance angiography, lower extremity, single station	May be used to evaluate downstream arterial disease in the thighs/legs in patients with pelvic inflow disease.
`72275`	Diagnostic spinal injection (epidural) — (Not typically related)	Data not available in the input.
`74183`	Computed tomography angiography, abdomen and pelvis; with contrast	Alternative cross-sectional vascular imaging modality used when MRA is contraindicated or CT angiography is preferred for surgical planning.
`93975`	Duplex scan of arterial inflow, upper and lower extremity arteries	Noninvasive physiologic testing often used alongside MRA to assess hemodynamics and locate stenoses.

OpenPayer

Summary & Overview

CPT 72198: Pelvic Magnetic Resonance Angiography (MRA)