Radiologic examination, spine, cervical; 2 or 3 views
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Not medically necessary - insufficient conservative treatment first
CommonCervical spine X-ray for non-traumatic neck pain often denied if conservative treatment (PT, medications, observation) not attempted first. Payers want 4-6 weeks conservative management before imaging unless red flags present (trauma, neurological deficits, severe pain).
Common Causes
- • Neck pain with no prior treatment - imaging ordered at first visit
- • No documentation of failed conservative treatment (PT, NSAIDs, muscle relaxants)
- • Chronic neck pain without new/worsening symptoms
Resolution Strategy
Appeal with documentation of: (1) Red flags (trauma, radiculopathy, severe pain limiting ADLs), OR (2) Failed conservative treatment (4-6 weeks PT, medications). If routine neck pain at first visit without red flags, denial often upheld.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For cervical spine X-ray with 2 or 3 views
Common Scenarios
Documentation Requirements
- Indication for cervical spine X-ray
- 2 or 3 views obtained
- Findings and interpretation
- Alignment assessment
- Report documentation
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes 2 or 3 views cervical spine
- Includes interpretation and report
- Single view coded separately
- Additional views coded separately
- Other spine regions coded separately
Exclusions
- 72020 (spine, single view)
- 72050 (cervical spine, minimum 4 views)
- 72070 (thoracic spine, 2 views)
- 72100 (lumbosacral spine, 2 or 3 views)
Coding Notes
Clinical scenarios
- Indication for cervical spine X-ray
- 2 or 3 views obtained
- Findings and interpretation
- Indication for cervical spine X-ray
- 2 or 3 views obtained
- Findings and interpretation
- Indication for cervical spine X-ray
- 2 or 3 views obtained
- Findings and interpretation
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 72040 is the billing code for "Radiologic examination, spine, cervical; 2 or 3 views". For cervical spine X-ray with 2 or 3 views
Medicare pays approximately $38.49 for CPT 72040 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 72040 has a total RVU of 2.30, broken down as: Work RVU 0.45, Practice Expense RVU 1.80, and Malpractice RVU 0.05. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 72040 is "Not medically necessary - insufficient conservative treatment first". Cervical spine X-ray for non-traumatic neck pain often denied if conservative treatment (PT, medications, observation) not attempted first. Payers want 4-6 weeks conservative management before imaging unless red flags present (trauma, neurological deficits, severe pain). Common causes include: Neck pain with no prior treatment - imaging ordered at first visit; No documentation of failed conservative treatment (PT, NSAIDs, muscle relaxants). Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 72040 include: Indication for cervical spine X-ray; 2 or 3 views obtained; Findings and interpretation; Alignment assessment. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 72040: Includes 2 or 3 views cervical spine. Includes interpretation and report Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 72040 include: 26 (Professional component only (interpretation)), TC (Technical component only (equipment/staff)), 59 (Distinct procedural service if performed separately). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 72040 is 8-12 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.