MRI Lumbar With Contrast CPT Code: 72158 Explained

The CPT code for an MRI of the lumbar spine with contrast is 72158. This code covers magnetic resonance imaging of the spinal canal and contents in the lumbar region when contrast material is administered. If the study is performed without contrast, use 72148; if both without and with contrast are performed, use 72158 as well, since it includes both sequences.

Understanding the correct CPT code is essential for accurate billing and reimbursement. This article explains the specific codes, when contrast is indicated, documentation requirements, and common billing pitfalls.

CPT Codes for Lumbar Spine MRI

The Current Procedural Terminology (CPT) system assigns distinct codes for MRI of the lumbar spine based on contrast usage:

• 72148: MRI lumbar spine without contrast
• 72149: MRI lumbar spine with contrast
• 72158: MRI lumbar spine without and with contrast

Note that 72149 is rarely used alone; most payers require both non-contrast and contrast sequences for a contrast-enhanced study, which is reported with 72158. According to Guilford Radiology, the code 72158 is specifically for "L-Spine Without and With Contrast." Similarly, Lexington Diagnostic lists 72158 as "MRI Lumbar Spine with and without contrast material."

For comparison, cervical spine codes are 72141 (without), 72142 (with), and 72156 (without and with). Thoracic spine codes are 72146 (without), 72147 (with), and 72157 (without and with).

When Is Contrast Used for Lumbar MRI?

Contrast material (typically gadolinium-based) is not routinely needed for lumbar spine MRI. It is indicated in specific clinical scenarios:

• History of cancer or suspected tumor
• Infection or inflammatory disease (e.g., discitis, osteomyelitis)
• Post-operative evaluation (e.g., suspected recurrent disc herniation vs. scar tissue)
• Multiple sclerosis or other demyelinating disease
• Vascular malformations

According to Guilford Radiology, "With and Without Contrast" is appropriate for "history of MS, transverse myelitis, tumors, cancer, post operative." For routine back pain, radiculopathy, or degenerative disc disease, a non-contrast MRI (72148) is usually sufficient.

Documentation and Billing Requirements

To support billing 72158, the medical record must clearly document:

• The medical necessity for contrast (e.g., suspected tumor, infection, or post-surgical evaluation)
• The order from the referring physician specifying contrast
• The actual administration of contrast and the sequences performed

Insufficient documentation may lead to claim denials. Noridian Medicare notes that if contrast is used, the appropriate code should be reported, but medical necessity must be established.

Common Billing Errors and How to Avoid Them

• Using 72149 instead of 72158: Most payers expect 72158 when both non-contrast and contrast images are obtained. 72149 is for contrast only, which is uncommon.
• Billing 72158 when contrast was not given: This is considered upcoding and may trigger audits.
• Missing modifier for bilateral or multiple studies: If multiple spine regions are imaged in the same session, appropriate modifiers may be needed.
• Not checking payer-specific policies: Some payers have local coverage determinations (LCDs) that specify when contrast is allowed.

Always verify with the specific payer, as policies vary. For example, Aetna provides a CPT code search tool to check precertification requirements.

Reimbursement and Cost Considerations

Reimbursement for 72158 is generally higher than for 72148 due to the additional contrast and imaging sequences. However, the exact amount depends on the payer, geographic location, and setting (facility vs. non-facility). Medicare rates are updated annually; providers should consult the current Medicare Physician Fee Schedule for exact figures.

Patients should be aware that contrast administration may incur additional costs, and some insurance plans require prior authorization for contrast-enhanced MRI.

Frequently Asked Questions

What is the difference between 72148 and 72158?

72148 is for MRI lumbar spine without contrast, while 72158 is for MRI lumbar spine without and with contrast. If contrast is administered, 72158 is the correct code.

Can I bill 72149 for contrast only?

Technically, 72149 exists for contrast only, but it is rarely used because most contrast-enhanced studies also include non-contrast sequences. Check payer policies.

Does Medicare cover MRI lumbar with contrast?

Medicare covers MRI lumbar with contrast when medically necessary. Documentation must support the indication. Prior authorization may be required in some cases.

What is the CPT code for MRI lumbar spine without contrast?

The CPT code is 72148.

For further details, refer to the AAPC description of 72148 and the AJNR supplement on MRI safety for contrast considerations.