Coding > Coding

72052 XRay Clinical Guidelines

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Agehman3:
hi...I work for an upper cervical chiro - we often take cpt 72052 x-rays does anyone know the coding/clinical guidelines for this? Sometimes they are approved; sometimes not.

shanbull:
We get our clinical guidelines from the insurer in most cases. The plans that require precertification for x-rays even give us a list of applicable criteria as well as which x-ray CPT codes they will pay for when billed by a chiropractor. It's possible that some insurers will pay for 72050 but not 75052 simply because they've decided that over 5 views is excessive for diagnosis. We keep a list of what is required and covered by each insurer handy.

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