How much does Medicare pay for CPT 72157?

Medicare allowed an average of $138.57 per service and paid $108.11 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1040.07, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 72157?

Mri scan of middle spinal canal before and after contrast. It was billed 60,887 times to 58,590 Medicare beneficiaries by 2,607 providers in 2024.

Does 72157 pay differently in an office than a hospital?

Yes. The allowed amount averaged $224.64 in an office setting and $104.73 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 72157 most?

Diagnostic Radiology, with 57,517 services from 2,456 clinicians. Next are Independent Diagnostic Testing Facility (IDTF), Interventional Radiology, Neurology.

CPT 72157

Mri scan of middle spinal canal before and after contrast

$138.57Medicare-allowed amount per service, averaged across 60,887 services

Providers submitted

$1040.07

Asking price, not received

Medicare allowed

$138.57

The fee schedule figure

Medicare paid

$108.11

Balance is patient coinsurance

Providers submitted an average of $1040.07 for this code and Medicare allowed $138.57 — 7.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $108.11 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $224.64
Hospital / facility: $104.73

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 17,184 services were billed in an office setting and 43,703 in a facility.

Services: 60,887
Beneficiaries: 58,590
Providers billing it: 2,607
Total allowed: $8,437,112

What Medicare pays for CPT 72157

Across 60,887 services billed by 2,607 providers to 58,590 beneficiaries, Medicare allowed an average of $138.57 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 72157

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	57,517	55,423	$133.28	2,456
Independent Diagnostic Testing Facility (IDTF)	1,981	1,868	$275.50	90
Interventional Radiology	611	595	$122.37	25
Neurology	265	252	$246.86	12
Nuclear Medicine	119	112	$149.23	5
Undefined Physician type	71	69	$100.09	3
Hematology-Oncology	70	29	$153.63	2
Internal Medicine	66	63	$170.22	4
Physician Assistant	39	37	$200.60	1
Family Practice	31	30	$224.45	2
Neurosurgery	31	27	$307.64	1
Pediatric Medicine	24	23	$148.00	2
Nurse Practitioner	24	24	$198.67	1
Radiation Oncology	23	23	$107.58	2
Sports Medicine	15	15	$223.16	1

72157 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New York	6,211	$158.10	$107.39	168
California	6,092	$158.53	$109.02	231
Texas	5,374	$127.36	$97.26	196
Florida	3,498	$161.81	$124.59	153
Massachusetts	3,426	$149.25	$105.47	108
Illinois	2,682	$121.31	$89.16	126
Pennsylvania	2,470	$118.92	$86.46	126
Michigan	2,231	$111.41	$84.82	97
Ohio	2,104	$116.72	$89.02	91
Minnesota	1,961	$191.31	$143.70	111
North Carolina	1,813	$118.81	$93.50	91
Virginia	1,674	$146.72	$108.25	67
Missouri	1,659	$109.49	$84.82	73
Arizona	1,555	$145.17	$112.25	71
Maryland	1,549	$181.52	$132.36	65
New Jersey	1,344	$179.75	$125.32	63
Colorado	1,148	$126.61	$93.67	53
Washington	1,141	$130.99	$93.37	57
Tennessee	1,064	$117.26	$96.08	54
Georgia	985	$121.20	$92.01	55
South Carolina	734	$122.68	$98.68	37
Wisconsin	712	$107.75	$82.36	42
Connecticut	698	$112.82	$83.58	35
Indiana	600	$113.20	$89.71	35
Oregon	597	$118.86	$89.77	29
Nevada	478	$180.37	$146.19	23
Kansas	459	$107.37	$85.90	24
Iowa	446	$103.27	$83.14	22
Arkansas	430	$102.69	$83.64	17
Utah	424	$106.63	$80.75	24
Oklahoma	423	$110.41	$88.93	24
Nebraska	413	$111.91	$91.35	24
Kentucky	394	$120.49	$95.06	19
Alabama	391	$136.38	$110.10	20
Mississippi	385	$103.32	$82.44	21
Rhode Island	377	$133.12	$95.41	12
District of Columbia	360	$158.42	$113.85	13
New Hampshire	304	$102.70	$77.74	16
South Dakota	269	$100.02	$76.30	9
Delaware	265	$113.73	$85.20	13
Idaho	244	$111.26	$88.18	13
Louisiana	239	$139.34	$111.82	13
Vermont	213	$122.80	$93.49	9
Montana	187	$102.39	$77.86	7
New Mexico	177	$133.99	$104.34	13
North Dakota	171	$100.90	$76.39	9
West Virginia	161	$146.98	$112.62	10
Alaska	140	$209.86	$131.81	5
Wyoming	69	$146.73	$116.75	5
Hawaii	66	$105.48	$79.70	4
Maine	43	$103.29	$79.86	2
ZZ	26	$101.66	$79.39	1
Puerto Rico	11	$104.46	$73.39	1

Related codes

72125Ct scan of upper spine without contrast$46.99
72100X-ray of lower and sacral spine$23.76
72148Mri scan of lower spinal canal without contrast$116.92
72110X-ray of lower and sacral spine$34.78
72170X-ray of pelvis$13.01
72141Mri scan of upper spinal canal without contrast$108.96
72131Ct scan of lower spine without contrast$53.06
72197Mri scan of pelvis before and after contrast$191.31
72146Mri scan of middle spinal canal without contrast$99.42
72128Ct scan of middle spine without contrast$46.63
72158Mri scan of lower spinal canal before and after contrast$149.73
72192Ct scan of pelvis without contrast$53.35

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.