Reimbursement
$312.29
Threshold
N/A
2026 Status
Active
What is CPT Code 73221?
CPT 73221 is defined as: Magnetic resonance imaging (MRI) of any joint of the upper extremity (e.g., shoulder, elbow, wrist) without the use of intravenous contrast material. This procedure provides high-resolution, multi-planar images of soft tissues, including ligaments, tendons, cartilage, and bone marrow. It is the gold standard for diagnosing rotator cuff tears, labral pathology, and internal derangement of joints.
This code is primarily used for Specialist services. It falls under the category of Radiology / Diagnostic Radiology and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
1.45
Physician Effort
PE (Non-Fac)
7.8
Practice Expense
Malpractice
0.1
Risk Factor
Total RVU
9.35
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency adjustment
Subject to -2.5% Efficiency Adjustment. CMS assumes that advances in coil technology and accelerated imaging sequences (e.g., AI-assisted reconstruction) have reduced physician effort.
pe redistribution
Independent imaging centers (POS 11) receive higher relative reimbursement than hospital-owned outpatient departments (POS 22) due to the 2026 indirect PE allocation shift.
conversion factor
Calculated at the 2026 Non-QP rate of $33.40.
Administrative Framework
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
mandatory elements
Permanent record of the images and a formal interpretation report. The study must cover the specific joint identified in the order.
supervision
Requires 'General Supervision' by a qualified physician.
equipment standards
The MRI unit must meet ACR (American College of Radiology) or equivalent accreditation standards for diagnostic quality.
prior authorization
Commonly required by commercial payers and Medicare Advantage plans; documentation of failed conservative therapy (e.g., PT) is often necessary.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Work RVU reduced by 2.5% efficiency adjustment. Conversion factor is $33.40.
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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