Billing code 72265: MyelographyMedicare rate & RVUs in Illinois
Radiologic supervision and interpretation of a lumbar or lumbosacral myelogram, used to evaluate the spinal canal and nerve-root anatomy.
Medicare pays $104.29–$114.15 for 72265 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 72265 covers
A lumbar or lumbosacral myelogram uses contrast introduced into the spinal canal, followed by radiographic imaging to show the canal and nearby nerve roots. A radiologist typically supervises the imaging and interprets the resulting study. It may help assess anatomy when evaluating suspected narrowing, nerve-root involvement, or changes after prior spine surgery, including when additional detail is needed beyond other imaging.
Report 72265 for the myelographic study of the lumbar or lumbosacral region, rather than for the contrast injection alone. Documentation should identify the region examined and include the myelographic images and interpretation. The contrast injection may be reported separately with 62284 when performed. CMS recognizes professional and technical components: modifier 26 reports the interpretation, modifier TC reports the equipment and staff, and billing without either modifier represents the global service.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 72265 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$104.29 to $114.15
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $113.41 | Unavailable |
| East St. Louis | $105.76 | Unavailable |
| Rest Of Illinois | $104.29 | Unavailable |
| Suburban Chicago | $114.15 | Unavailable |
How the 72265 rate is calculated
Each of 72265’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 72265
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.81Practice expense 2.43Malpractice 0.06
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 72265
The CMS indicators that decide how 72265 is paid alongside other services.
CMS payment indicators · 72265
Myelography
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
72265 without 26 · national office
$110.22
Myelography
72265-26 · Professional component
$40.08
Pays only the interpretation and report.
72265 compared with similar codes
Compare codes
72265 vs 72240 vs 72255 vs 72270 vs 62284: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 72240Myelography
- This code is for a cervical myelogram; 72265 is for the lumbar or lumbosacral region.
- 72255Myelography
- This code is for a thoracic myelogram; 72265 is for the lumbar or lumbosacral region.
- 72270Myelography
- Use 72270 when the myelographic examination covers two or more spinal regions. Use 72265 for the lumbar or lumbosacral region alone.
- 62284Myelogram injection
- 62284 reports the spinal contrast injection for myelography or CT; 72265 reports the lumbar or lumbosacral myelographic imaging service.
72265 billing questions
When should 72265 be used instead of 72270?
Use 72265 for a lumbar or lumbosacral myelogram. Use 72270 when the myelographic examination covers two or more spinal regions.
Does 72265 include the contrast injection?
The code represents the lumbar or lumbosacral myelographic imaging service, not the injection alone. When performed, the spinal contrast injection may be reported separately with 62284.
Which modifier reports only the interpretation?
Append modifier 26 for the professional interpretation. Modifier TC reports the technical service, and billing without either modifier represents the global service.
How does 72265 differ from 62284?
72265 covers the radiologic myelogram service for the lumbar or lumbosacral region. Code 62284 represents the spinal contrast injection used for myelography or CT.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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