Billing code 72197: MRI pelvisMedicare rate & RVUs in Oklahoma
Reports pelvic MRI images obtained before and after contrast to evaluate pelvic organs, soft tissues, or a suspected mass or disease process.
Medicare pays $305.63 for 72197 in the office in Oklahoma (Oklahoma). 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 72197 covers
The examination uses magnetic resonance imaging to assess pelvic organs and soft tissues, with image sets acquired before and after contrast. Clinicians may request it to characterize a pelvic mass or evaluate conditions involving structures such as the uterus, ovaries, prostate, rectum, or pelvic soft tissues. A technologist performs the image acquisition, and a radiologist typically interprets the study in an imaging center or hospital department.
Report 72197 when the documented pelvic MRI includes both precontrast and postcontrast imaging; a study performed only without contrast or only with contrast belongs to a different code in this series. The report should identify the pelvic anatomy examined and document the precontrast and postcontrast sequences and the diagnostic interpretation. Medicare recognizes a professional component for interpretation and a technical component for equipment and staff; bill the global service without a component modifier, or use modifier 26 or TC for the respective component. The diagnostic imaging multiple procedure reduction applies to both components.
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.
72197 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | $305.63 | Unavailable |
How the 72197 rate is calculated
Each of 72197’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 · 72197
RVUs × geographic indexes × conversion factor
Work2.15
2.15 RVUs× 1.000 GPCI
Practice expense7.70
7.70 RVUs× 1.000 GPCI
Malpractice0.16
0.16 RVUs× 1.000 GPCI
Adjusted RVUs
10.0100
Conversion factor
$33.4009
Medicare rate
$334.34
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 72197
The CMS indicators that decide how 72197 is paid alongside other services.
CMS payment indicators · 72197
MRI pelvis
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 4 | Diagnostic imaging reduction applies to the technical component (and professional component) of additional services. |
| 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
72197 without 26 · national office
$334.34
MRI pelvis
72197-26 · Professional component
$101.54
Pays only the interpretation and report.
72197 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 72195Pelvic MRI
- Choose 72195 for pelvic MRI without contrast. Choose 72197 when both precontrast and postcontrast image sets are performed.
- 72196MRI pelvis
- 72196 describes pelvic MRI with contrast only; 72197 describes a study with imaging both before and after contrast.
- 72198Pelvic MRA
- 72198 is pelvic MR angiography, focused on vessels. Use 72197 for a general pelvic MRI examination with and without contrast.
- 72194Ct pelvis w/o & w/dye
- 72194 is CT imaging of the pelvis without and with contrast. 72197 is the corresponding MRI approach, not CT.
72197 billing questions
When should 72197 be selected instead of 72195?
Use 72197 when the pelvic MRI includes imaging both before and after contrast. Code 72195 describes a pelvic MRI performed without contrast.
How does 72197 differ from 72196?
72197 represents imaging before and after contrast; 72196 is for imaging with contrast only. Select according to the sequences actually performed and documented.
Can the professional and technical portions be billed separately?
Yes. Modifier 26 identifies the interpretation, and modifier TC identifies the equipment and staff portion. Billing without either modifier represents the global service.
Does the multiple procedure reduction affect both portions?
Yes. CMS applies the diagnostic imaging multiple procedure reduction to the technical and professional components.
Is 72197 reported per sequence or per pelvic organ?
It represents the pelvic MRI examination, not each sequence or organ evaluated. The report should support that the examination included both precontrast and postcontrast imaging.
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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