$224.20
72195 is for pelvic MRI without contrast. Use 72196 when contrast is used for the examination.
On this page
CMS RVU26D · Effective 2026-10-01
72196 MRI pelvis Medicare reimbursement rates in Vermont
Report this code for a pelvic MRI performed with contrast when the examination does not include both precontrast and postcontrast imaging. Compare 72196 office and facility rates across CMS payment localities in Vermont.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 72196 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$264.15
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
MRI
About 72196: Pelvic MRI with contrast only
Report this code for a pelvic MRI performed with contrast when the examination does not include both precontrast and postcontrast imaging.
This service covers MRI imaging of the pelvis performed with contrast, commonly a gadolinium-based agent. A radiologic technologist acquires the images in a hospital or outpatient imaging center, and a radiologist interprets them. Pelvic MRI may be ordered to assess a mass, characterize soft-tissue findings, or evaluate suspected infection when contrast-enhanced imaging is requested. The documented examination must support the pelvic region and use of contrast.
Choose this code for a contrast-only examination, rather than a study that includes imaging both before and after contrast. The imaging report and order should identify the pelvic anatomy, contrast use, and findings. The service may be billed globally, or the interpretation and imaging equipment and staff portions may be billed separately with modifiers 26 and TC. When multiple diagnostic imaging services are performed, the CMS multiple procedure reduction applies to both the technical and professional components.
CMS billing rules for 72196
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
- Multiple procedures
- Diagnostic imaging multiple procedure reduction applies to the technical and professional components.
Where the value comes from
- Work RVU1.69 · 21%
- Practice expense (office) RVU6.22 · 77%
- Malpractice RVU0.12 · 1%
2.8K
Medicare services in 2024 · #2228 by national volume
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.
72196 compared with similar codes
Office rates for Vermont, from the same CMS release.
$329.13
72197 includes pelvic MRI before and after contrast; 72196 is for the contrast-only examination.
$222.45
72193 describes pelvic CT with contrast, not MRI. The modality documented in the imaging report determines which code applies.
Compare 72196 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Vermont →
Office / nonfacility
$264.15
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 72196 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
8,063
- Code
- 72196
- Physician work
- 1.69
- Practice expense
- 6.22
- Malpractice
- 0.12
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.69 | × 1.000 | 1.6900 |
| Practice expense | 6.22 | × 0.990 | 6.1578 |
| Malpractice | 0.12 | × 0.506 | 0.0607 |
| Total RVUs | 7.9085 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$264.15
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.69 | 1 |
| Practice expense | 6.22 | 0.99 |
| Malpractice | 0.12 | 0.506 |
(1.69 × 1 + 6.22 × 0.99 + 0.12 × 0.506) × $33.4009 = $264.15
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
72196 billing questions
How does this differ from 72195?
72196 represents pelvic MRI performed with contrast; 72195 represents pelvic MRI without contrast. Select the code that matches the sequences documented in the imaging report.
When should 72197 be used instead?
Use 72197 when the pelvic MRI includes imaging both before and after contrast. Use 72196 when the examination is performed with contrast only.
Can the interpretation and imaging service be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service. Billing without either modifier represents the global service.
What happens when another diagnostic imaging service is performed?
The CMS multiple procedure reduction applies to both the professional and technical components when multiple diagnostic imaging services are performed.
What documentation supports 72196?
The order and imaging report should establish that the study covers the pelvis and was performed with contrast, without the precontrast and postcontrast protocol represented by 72197.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
8,06072195,,Mri pelvis w/o dye,A,,1.42,5.30,,5.30,NA,0.09,6.81,6.81,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,09,0,88,7.78,7.78,0.10
8,06172195,26,Mri pelvis w/o dye,A,,1.42,0.51,,0.51,,0.07,2.00,2.00,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,09,0,88,0.00,0.00,0.00
8,06272195,TC,Mri pelvis w/o dye,A,,0.00,4.79,,4.79,NA,0.02,4.81,4.81,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,01,0,88,7.27,7.27,0.03
8,06372196,,Mri pelvis w/dye,A,,1.69,6.22,,6.22,NA,0.12,8.03,8.03,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,09,0,88,11.21,11.21,0.15
8,06472196,26,Mri pelvis w/dye,A,,1.69,0.60,,0.60,,0.09,2.38,2.38,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,09,0,88,0.00,0.00,0.00
8,06572196,TC,Mri pelvis w/dye,A,,0.00,5.62,,5.62,NA,0.03,5.65,5.65,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,02,0,88,10.61,10.61,0.06
8,06672197,,Mri pelvis w/o & w/dye,A,,2.15,7.70,,7.70,NA,0.16,10.01,10.01,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,09,0,88,11.38,11.38,0.18
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817