CPT 73020 Single‑View Shoulder X‑Ray Reimbursement | OpenPayer

Summary & Overview

CPT 73020: Single View X‑ray of the Shoulder

CPT code 73020 denotes a single view radiographic examination of the shoulder. As a common diagnostic imaging code, it is routinely used in emergency departments, outpatient radiology suites, and ambulatory imaging centers to evaluate acute shoulder pain, suspected fractures, and dislocations. This code matters nationally because shoulder radiography represents a high‑volume, low‑complexity service with implications for imaging utilization, coding compliance, and claims processing.

Key payers covered in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for utilization and reimbursement patterns, coding and billing considerations relevant to single‑view shoulder X‑rays, and clinical context describing when a single view is appropriate versus multiview imaging. The publication also summarizes common modifiers used in practice and highlights areas where payers commonly apply medical necessity or bundling edits.

This report is intended for clinicians, billing professionals, and policy analysts looking for a concise reference on CPT code 73020, presenting clinical purpose, service settings, payer scope, and information needed for accurate claim submission and reporting.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare73020CPTshoulder-xrayradiologydiagnostic-imagingoutpatient-imagingemergency-departmentmedical-billing

Billing Code Overview

CPT code 73020 reports a single view X‑ray of the shoulder. This service is an imaging diagnostic procedure used to capture a single radiographic view to evaluate shoulder anatomy, commonly employed for acute injury assessment, suspected fracture, dislocation, or focal shoulder pain.

Service type: Single‑view radiographic imaging of the shoulder
Typical site of service: Outpatient radiology department, hospital radiology, ambulatory imaging center, or emergency department

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 45-year-old construction worker presents to an outpatient radiology clinic and reports acute right shoulder pain after a fall onto the outstretched hand. The clinician documents focal lateral shoulder tenderness, limited active range of motion, and concern for possible fracture or dislocation. Orders include a single-view radiograph of the right shoulder to evaluate bone alignment, suspected clavicle or proximal humerus fracture, and to screen for dislocation. The radiology technologist performs one AP (internal/external rotation as appropriate) single view shoulder X-ray, documents laterality with modifier RT, acquires the image in the outpatient imaging suite, and forwards the exam to the interpreting radiologist. The radiologist provides an official report describing fracture presence/absence, alignment, and any acute osseous abnormality. Typical site of service: outpatient radiology department or ambulatory imaging center. Service type: diagnostic plain radiography (single view).

Coding Specifications

Modifier	Description	When to Use
`RT`	Right side	Use when imaging the right shoulder to indicate laterality.
`LT`

CPT 73223: MRI Upper Extremity, With and Without Contrast

CPT-73201-CT-UPPER-EXTREMITY-WITH-CONTRAST

CPT 73201: CT of Upper Extremity With Contrast

CPT-73220-MRI-UPPER-EXTREMITY-NON-JOINT-WITH-AND-WITHOUT-CONTRAST

CPT 73220: MRI Upper Extremity (Non-Joint), With and Without Contrast

73110-RADIOLOGIC-EXAMINATION-WRIST-COMPLETE-MINIMUM-OF-3

CPT 73110: Radiologic Examination of Wrist, Complete (≥3 Views)

CPT-73100-WRIST-XRAY-TWO-VIEWS

CPT 73100: Two-View Radiographic Examination of the Wrist

CPT-73092-INFANT-UPPER-EXTREMITY-RADIOGRAPHY

CPT 73092: Infant Upper Extremity Radiography

CPT-73222-MRI-UPPER-EXTREMITY-WITH-CONTRAST

CPT 73222: MRI Upper Extremity Joint With Contrast

CPT-73070-ELBOW-XRAY-2-VIEWS

CPT 73070: Elbow X‑ray, Minimum 2 Views

CPT-73085-ELBOW-ARTHROGRAPHY-IMAGING-INTERPRETATION

CPT 73085: Elbow Arthrography, Imaging Supervision and Interpretation

CPT-73202-CT-UPPER-EXTREMITY-WITH-AND-WITHOUT-CONTRAST

CPT 73202: CT Upper Extremity, Without and With Contrast

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Taxonomy Code	Specialty	Notes
2085R0200X	Diagnostic Radiology	Most common specialty interpreting and ordering shoulder radiographs.
2086S0202X	Orthopedic Surgery	Orthopedists commonly order and interpret images to guide fracture/dislocation management.
207L00000X	Family Medicine	Often orders initial plain films in urgent care or outpatient settings.
207R00000X	Emergency Medicine	Frequently orders single-view shoulder X-rays for acute trauma evaluation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S42.2X0A`	Fracture of shaft of clavicle, initial encounter for closed fracture	Single-view shoulder X-ray may be used to evaluate suspected clavicle fracture after trauma.
`S42.20XA`	Fracture of clavicle, unspecified, initial encounter for closed fracture	Used when clavicle fracture is suspected and imaging is obtained to confirm.
`S42.21XA`	Fracture of lateral end of clavicle, initial encounter for closed fracture	Single view can help identify lateral clavicle fractures.
`S43.001A`	Anterior dislocation of right shoulder, initial encounter	Single-view radiograph may be an initial imaging to assess for dislocation or reduction placement.
`M75.1`	Rotator cuff tear or rupture, not specified as traumatic	Single-view X-ray can be used to evaluate bony abnormalities or degenerative changes associated with cuff pathology.
`M75.100`	Unspecified rotator cuff tear or rupture of unspecified shoulder	Radiographs help rule out osseous causes of shoulder pain prior to advanced imaging.
`M75.9`	Shoulder lesion, unspecified	General shoulder pain indication for plain radiography to screen for fracture, arthritis, or other bony pathology.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`73030`	Shoulder; minimum of two views	Performed when additional views (two or more) are required to fully evaluate suspected fracture or dislocation following a single view.
`73040`	Shoulder; complete, minimum of three views	Used when a comprehensive shoulder series is indicated for detailed assessment of complex trauma or preoperative planning.
`73060`	Shoulder; two or three views, each with special techniques (e.g., scapular Y)	Applied when specialized projections are necessary to assess alignment or glenoid involvement.
`72040`	Radiologic examination, scapula; complete, minimum of two views	Performed when scapular injury is suspected in addition to shoulder evaluation.
`73090`	Radiologic examination, clavicle; minimum of two views	Performed when clavicle fracture is suspected along with shoulder trauma; may be ordered after or alongside the shoulder single view.

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