Radiologic examination, spine, lumbosacral; minimum 4 views
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Not medically necessary - conservative treatment not attempted
Very Common72110 (lumbar spine X-ray 4+ views) is heavily scrutinized for low back pain. Most payers require 4-6 weeks of conservative treatment (PT, NSAIDs, activity modification) before approving lumbar imaging unless red flags present. This is the most commonly denied imaging code for non-compliance with treatment guidelines.
Common Causes
- • Lumbar X-ray ordered at first visit for acute low back pain without red flags
- • No documentation of conservative treatment trial
- • Chronic back pain without new symptoms or failed treatment documentation
Resolution Strategy
Appeal with: (1) Red flags (trauma, neurological deficits, saddle anesthesia, bowel/bladder changes, progressive weakness), OR (2) Failed 4-6 weeks conservative treatment. Workers comp cases often approved without conservative treatment requirement. If routine back pain without trial of treatment, denial typically upheld.
2. Should bill 72100 (2-3 views) instead - 4+ views not necessary
Common72110 requires minimum 4 views and higher complexity clinical indication. Payers may downgrade to 72100 (2-3 views) if comprehensive oblique views not medically necessary. Simple low back pain evaluation typically doesn't require 4+ view study.
Common Causes
- • Ordered 4-view study for routine low back pain evaluation
- • No documentation of need for oblique views (e.g., suspected spondylolisthesis)
- • Only AP and lateral views obtained but 72110 billed
Resolution Strategy
Verify actual number of views documented. If 4+ views truly obtained and documented, appeal with clinical indication for comprehensive study (suspected spondylolisthesis, scoliosis evaluation, pre-surgical planning). If fewer views or routine evaluation, downgrade to 72100 appropriate.
Relative Value Units (RVUs)
Calculator →
Clinical Information
When to Use
For lumbosacral spine X-ray with minimum 4 views
Common Scenarios
Documentation Requirements
- Indication for lumbosacral spine X-ray
- Minimum 4 views obtained
- Findings and interpretation
- Alignment assessment
- Report documentation
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes minimum 4 views lumbosacral spine
- Includes interpretation and report
- Fewer views coded separately
- Additional views bundled
- Other spine regions coded separately
Exclusions
- 72020 (spine, single view)
- 72100 (lumbosacral spine, 2 or 3 views)
- 72070 (thoracic spine, 2 views)
- 72040 (cervical spine, 2 or 3 views)
Coding Notes
Clinical scenarios
- Indication for lumbosacral spine X-ray
- Minimum 4 views obtained
- Findings and interpretation
- Indication for lumbosacral spine X-ray
- Minimum 4 views obtained
- Findings and interpretation
- Indication for lumbosacral spine X-ray
- Minimum 4 views obtained
- Findings and interpretation
Who are you?
Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
Automate Coding
Let OrbDoc AI automatically suggest codes from your clinical notes.
Patient? Check your bill.
Use our free analyzer to understand charges and spot errors.
Analyze My BillAsk OrbDoc AI
Get instant answers about 72110 - pricing, bundling rules, or billing questions.
Ask a QuestionFrequently Asked Questions
CPT 72110 is the billing code for "Radiologic examination, spine, lumbosacral; minimum 4 views". For lumbosacral spine X-ray with minimum 4 views
Medicare pays approximately $50.46 for CPT 72110 (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 72110 has a total RVU of 3.17, broken down as: Work RVU 0.70, Practice Expense RVU 2.40, and Malpractice RVU 0.07. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 72110 is "Not medically necessary - conservative treatment not attempted". 72110 (lumbar spine X-ray 4+ views) is heavily scrutinized for low back pain. Most payers require 4-6 weeks of conservative treatment (PT, NSAIDs, activity modification) before approving lumbar imaging unless red flags present. This is the most commonly denied imaging code for non-compliance with treatment guidelines. Common causes include: Lumbar X-ray ordered at first visit for acute low back pain without red flags; No documentation of conservative treatment trial. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 72110 include: Indication for lumbosacral spine X-ray; Minimum 4 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 72110: Includes minimum 4 views lumbosacral spine. Includes interpretation and report Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 72110 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 72110 is 15-20 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.