How much does Medicare pay for CPT 72158?

Medicare allowed an average of $149.73 per service and paid $115.83 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1089.18, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 72158?

Mri scan of lower spinal canal before and after contrast. It was billed 162,555 times to 157,079 Medicare beneficiaries by 5,579 providers in 2024.

Does 72158 pay differently in an office than a hospital?

Yes. The allowed amount averaged $226.28 in an office setting and $104.69 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 72158 most?

Diagnostic Radiology, with 146,198 services from 4,994 clinicians. Next are Independent Diagnostic Testing Facility (IDTF), Interventional Radiology, Orthopedic Surgery.

CPT 72158

Mri scan of lower spinal canal before and after contrast

$149.73Medicare-allowed amount per service, averaged across 162,555 services

Providers submitted

$1089.18

Asking price, not received

Medicare allowed

$149.73

The fee schedule figure

Medicare paid

$115.83

Balance is patient coinsurance

Providers submitted an average of $1089.18 for this code and Medicare allowed $149.73 — 7.3× 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 $115.83 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $226.28
Hospital / facility: $104.69

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. 60,220 services were billed in an office setting and 102,335 in a facility.

Services: 162,555
Beneficiaries: 157,079
Providers billing it: 5,579
Total allowed: $24,339,360

What Medicare pays for CPT 72158

Across 162,555 services billed by 5,579 providers to 157,079 beneficiaries, Medicare allowed an average of $149.73 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 72158

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	146,198	141,439	$140.36	4,994
Independent Diagnostic Testing Facility (IDTF)	9,981	9,585	$269.09	319
Interventional Radiology	1,873	1,837	$117.21	68
Orthopedic Surgery	1,550	1,409	$207.35	68
Neurosurgery	855	799	$240.58	32
Physical Medicine and Rehabilitation	282	272	$237.17	15
Physician Assistant	268	265	$192.38	8
Nuclear Medicine	218	212	$146.66	10
Neurology	195	193	$173.65	11
Internal Medicine	193	190	$161.74	8
Family Practice	190	189	$218.43	12
Nurse Practitioner	156	147	$146.67	5
Hematology-Oncology	133	85	$146.63	5
Undefined Physician type	100	97	$125.15	4
Pediatric Medicine	90	88	$230.95	4

72158 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
California	13,254	$166.26	$113.59	450
Texas	12,871	$154.13	$118.35	392
Florida	11,137	$183.16	$141.30	362
New York	10,937	$172.24	$118.89	289
Illinois	6,926	$131.58	$97.28	241
Pennsylvania	6,624	$130.91	$97.37	253
Massachusetts	6,372	$152.34	$107.56	191
North Carolina	6,226	$143.28	$112.38	222
Michigan	5,888	$116.96	$88.14	167
Ohio	5,314	$127.58	$97.52	182
Minnesota	5,023	$165.00	$123.63	198
Virginia	4,835	$145.18	$109.28	154
Tennessee	4,438	$132.00	$107.88	140
Georgia	4,328	$143.53	$110.90	158
Missouri	4,145	$116.95	$89.45	155
New Jersey	3,577	$197.87	$138.23	128
Arizona	3,388	$167.00	$128.45	108
Washington	3,012	$148.20	$107.91	112
Maryland	3,008	$192.21	$139.42	110
South Carolina	2,898	$137.88	$110.22	97
Alabama	2,793	$178.54	$147.03	113
Colorado	2,577	$144.30	$105.08	107
Indiana	2,497	$133.85	$106.50	97
Wisconsin	2,395	$117.32	$90.27	108
Connecticut	2,344	$173.38	$126.43	86
Mississippi	2,172	$137.56	$114.42	78
Iowa	1,906	$125.12	$100.96	62
Louisiana	1,739	$154.94	$126.19	75
Arkansas	1,696	$121.79	$99.86	63
Kansas	1,585	$120.35	$95.30	67
Oregon	1,524	$126.47	$95.61	53
Nebraska	1,465	$127.67	$102.12	51
Kentucky	1,438	$131.44	$106.33	50
Oklahoma	1,260	$126.03	$100.31	53
Nevada	1,098	$170.22	$130.20	38
Utah	1,014	$123.77	$96.59	43
Delaware	834	$128.67	$96.46	24
Rhode Island	805	$157.21	$113.16	22
New Hampshire	804	$112.19	$84.31	35
Idaho	716	$117.94	$92.47	23
North Dakota	710	$110.28	$82.57	28
West Virginia	688	$122.77	$92.03	35
District of Columbia	634	$158.48	$112.01	20
New Mexico	590	$151.86	$117.71	29
South Dakota	570	$105.96	$78.38	18
Montana	566	$118.33	$90.32	18
Maine	495	$126.98	$95.28	21
Vermont	486	$122.56	$94.16	14
Alaska	383	$178.65	$105.42	13
Hawaii	194	$143.34	$103.65	10
Wyoming	178	$142.69	$107.93	8
Puerto Rico	103	$125.70	$96.66	3
Guam	42	$323.21	$201.89	1
ZZ	16	$101.23	$79.06	1
XX	15	$101.27	$76.61	1
AA	11	$102.68	$79.96	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
72192Ct scan of pelvis without contrast$53.35
72156Mri scan of upper spinal canal before and after contrast$142.72

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.