CPT code 73221 is the Current Procedural Terminology designation for a magnetic resonance imaging (MRI) procedure of any upper extremity joint performed without contrast material, such as the shoulder, elbow, wrist, or hand.
The term “without contrast material” indicates that no injected dye (such as gadolinium) is used to enhance the imaging. The imaging relies on the MRI machine’s magnetic and radiofrequency fields to produce detailed cross-sectional images of soft tissues, cartilage, bone, and joint structures.
Clinical uses include:
- Evaluation of soft tissue and ligament structures
- Assessment of cartilage, joint surfaces, and bone marrow changes
- Detection of tears, inflammation, and degenerative changes
- Planning for surgical or non-surgical interventions
This code is part of the Diagnostic Radiology (Imaging) Procedures of the Upper Extremities section of the CPT manual and is specifically differentiated from related codes that use contrast or involve non-joint imaging.
How the Procedure Works
MRI Technology Overview
MRI employs strong magnetic fields and radio waves to align and disrupt hydrogen protons within body tissues. These protons emit signals captured by the scanner and processed into images. Unlike X-rays or CT scans, MRI does not use ionizing radiation.
Typical Workflow
- Patient Preparation
Patient removes metal objects; lies on table that slides into the MRI bore. - Positioning
A specialized coil is placed around the targeted joint to optimize signal quality. - Image Acquisition
Multiple sequences (e.g., T1, T2, proton density) are obtained to visualize anatomy and pathology. - Image Interpretation
A radiologist reviews sequences for abnormalities, generates a report. - Documentation for Coding
The report must support the use of CPT 73221 (no contrast, joint focus).
When CPT Code 73221 Is Appropriate
Common Clinical Indications
CPT 73221 is indicated when non-contrast MRI of an upper extremity joint is clinically necessary, for example to evaluate:
- Rotator cuff injuries or tears
- Labral pathology
- Ligamentous injuries
- Cartilage damage or early osteoarthritis
- Unexplained joint pain or swelling
- Synovitis or joint effusion
- Degenerative joint changes
Differences from Related Codes
- 73218 – MRI other than joint of the upper extremity (e.g., humerus, forearm) without contrast.
- 73222 – MRI with contrast material of an upper extremity joint.
- 73223 – MRI both without and with contrast of an upper extremity joint.
Choosing the correct code depends on the clinical order, use of contrast, and the specific anatomical target.
Billing and Documentation Requirements
Coders and providers must ensure medical necessity is clearly documented, and that the report supports the absence of contrast and joint focus. Modifier usage is critical for accurate billing:
Common Modifiers with 73221
- -RT / -LT – denotes side of body (right/left)
- 26 – Professional component (interpretation only)
- TC – Technical component (facility/equipment costs)
- 59 – Distinct procedural service
- 76 / 77 – Repeat procedures by same or different provider
Accurate use of modifiers affects reimbursement and compliance with payer policies.
Clinical Scenarios and Coding Examples
Example 1: Shoulder Pain Evaluation
Order: MRI of right shoulder joint without contrast.
Appropriate code: 73221-RT, supported by clinical documentation of shoulder instability or suspected cuff tear.
Example 2: Wrist Injury After Trauma
Patient with persistent wrist pain post-trauma. MRI requested to assess TFCC (triangular fibrocartilage complex).
Appropriate code: 73221-LT with matching ICD-10 diagnosis supporting instability or tear.
Example 3: Postoperative Joint Evaluation
Follow-up MRI to assess healing progression after rotator cuff repair may be coded with repeat procedure modifiers if appropriate.
Unique Clinical Takeaways
1. Functional Implications of Non-Contrast MRI in Joint Assessment
Non-contrast MRI (73221) provides detailed soft tissue contrast without systemic exposure to contrast agents. For patients with renal insufficiency or contrast allergies, 73221 allows critical visualization of structures such as tendons, cartilage, and ligaments without nephrotoxic risk.
2. Differential Diagnosis Beyond Musculoskeletal Injury
In addition to trauma and degeneration, non-contrast MRI can help differentiate inflammatory arthropathies (e.g., rheumatoid arthritis) from mechanical disorders when clinical exam and X-rays are inconclusive. While contrast can enhance synovial assessment, careful sequence selection can reveal synovitis, effusions, and marrow edema—important for early treatment planning.
3. Soft Tissue Versus Osseous Pathology Identification
MRI without contrast excels at distinguishing bone marrow abnormalities (e.g., edema, occult fractures) from soft tissue pathology. In complex joints like the wrist, this distinction influences clinical decisions such as need for surgical referral versus conservative management.
4. Impact on Rehabilitation and Functional Outcomes
Detailed MRI findings using 73221 can be integrated into physical therapy planning, enabling targeted rehabilitation for conditions such as rotator cuff tears or ligament sprains. Precise imaging leads to tailored protocols to maximize functional recovery.
Limitations and Exclusions
- CPT 73221 does not cover contrast-enhanced imaging; using gadolinium or other agents requires codes 73222 or 73223.
- It is not appropriate for non-joint or whole extremity imaging without specific joint focus; such imaging should use related codes like 73218.
- Billing must align with payer policies, which often require proof of medical necessity and adherence to local coverage determinations