Which payers have published criteria for CT arm without contrast (CPT 73200)?

The imaging guidelines used by Aetna, Anthem BCBS, Cigna, Medicare, UnitedHealthcare include criteria that apply to this study. Whether a specific patient's plan requires prior authorization depends on the plan, so confirm on the payer's portal or by phone before scheduling.

Who reviews prior authorization requests for CT arm without contrast (CPT 73200)?

Most commercial payers hand imaging reviews to a radiology benefit manager. For the payers tracked here, requests are reviewed using guidelines from eviCore, Carelon, CMS, UnitedHealthcare / eviCore. The request is submitted through that organization's portal rather than the health plan's general line.

What should be in the clinical notes before requesting CT arm without contrast (CPT 73200)?

Reviewers look for a recent office visit that documents the symptoms and how long they have lasted, exam findings, results of any earlier imaging, treatments already tried and how the patient responded, and the specific question the study is expected to answer. The diagnosis code on the request should match what the notes describe.

How much does CT arm without contrast (CPT 73200) cost?

Across 1,089 hospitals that publish their negotiated rates, the median commercial insurance rate is $705, with the middle half of rates between $318 and $1,555. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if CT arm without contrast (CPT 73200) is denied?

Read the denial letter for the stated reason, then request a peer-to-peer conversation between the ordering clinician and the reviewing physician, which often resolves missing-information denials. If that fails, file a written appeal that answers the stated reason directly and attach the supporting notes. The denial letter lists the deadline and where to send the appeal.

CPT 73200: CT arm without contrast - Prior Authorization and Price

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CPT 73200

CT imaging of the arm performed without using contrast dye.

CT Arm & Shoulder

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Peripheral Nerve and Neuromuscular Disorders (PNND) Imaging Guidelines 1.0.2026, effective Feb 3, 2026	9 that name this code
Anthem BCBS	Carelon	Imaging of the extremities effective Sep 19, 2026 Oncologic imaging effective Apr 4, 2026	31 that name this code
Cigna	eviCore	Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Peripheral Nerve and Neuromuscular Disorders (PNND) Imaging Guidelines 1.0.2026, effective Feb 3, 2026	9 that name this code
Medicare	CMS	NCD 220.1: Computed Tomography effective Mar 12, 2008	1 that name this code
Original Medicare does not run a prior authorization program for outpatient imaging; claims are judged against the coverage policies above. Medicare Advantage plans set their own prior authorization rules.
UnitedHealthcare	UnitedHealthcare / eviCore	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	9 that name this code

Guidelines collected from the payers' published documents on September 29, 2026. Payers revise these documents during the year. Open the guideline link to confirm the current version before you submit.

Conditions the guidelines address for this study

These are the clinical situations where payer guidelines discuss CT arm without contrast. Each has its own criteria for when the study is considered appropriate.

Acute traumatic injuries –not otherwise specified Anthem BCBS
Adhesive capsulitis (Adult only) Anthem BCBS
Avascular necrosis Anthem BCBS
Brachial plexopathy Anthem BCBS
Brachial plexus mass Anthem BCBS
Cancer screening, not otherwise specified Anthem BCBS
Capitellar osteochondritis Anthem BCBS
Colorectal cancer screening Anthem BCBS
Congenital or developmental anomalies of the extremity (Pediatric only) Anthem BCBS
Entrapment neuropathy (excluding carpal and cubital tunnel) Anthem BCBS
Fracture Anthem BCBS
Hemarthrosis Anthem BCBS
Histiocytic Neoplasms Anthem BCBS
Indeterminate bone lesion Anthem BCBS
Intra-articular loose body Anthem BCBS
Juvenile idiopathic arthritis (Pediatric only) Anthem BCBS
Labral tear – shoulder Anthem BCBS
Ligament and tendon injuries – wrist Anthem BCBS
Myositis Anthem BCBS
Neuroendocrine Tumors Anthem BCBS
Neuropathic osteoarthropathy (Charcot joint) (Adult only) Anthem BCBS
Osteochondral lesion (including osteochondritis dissecans, transient dislocation of patella) Anthem BCBS
Osteomyelitis Anthem BCBS
Paget disease Anthem BCBS
Perioperative Imaging (including delayed hardware failure), not otherwise specified Anthem BCBS
Pigmented villonodular synovitis Anthem BCBS
Rotator cuff tear Anthem BCBS
Shoulder arthroplasty, presurgical planning Anthem BCBS
Soft tissue infection Anthem BCBS
Soft tissue mass – not otherwise specified Anthem BCBS
Upper extremity pain, not otherwise specified Anthem BCBS
Post-Operative Follow-Up Aetna · Cigna · UnitedHealthcare
Arthritis and Joint Degeneration Aetna · Cigna · UnitedHealthcare
Brachial Plexus Aetna · Cigna · UnitedHealthcare
Chondral/Osteochondral Lesions Aetna · Cigna · UnitedHealthcare
Foreign and Loose Bodies Aetna · Cigna · UnitedHealthcare
General Pain Aetna · Cigna · UnitedHealthcare
Joint Instability and Dysfunction Aetna · Cigna · UnitedHealthcare
Osteonecrosis/Avascular Necrosis Aetna · Cigna · UnitedHealthcare
Computed Tomography Medicare

Typical price

Commercial insurance, median

$705

Middle half of rates: $318 to $1,555

Medicare, hospital outpatient

$107

Facility payment

Medicare, physician fee schedule

$161

National, non-facility

Commercial figures come from negotiated rates published by 1,089 hospitals; Medicare figures from CMS fee schedules. Rates vary widely by hospital and plan. Pricing data from CenterIQ.

Get notified when the rules for this study change

Payers update imaging guidelines several times a year. We will email you when the criteria for CT arm without contrast change.

CPT 73200: CT arm without contrast - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

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CPT 73200: CT arm without contrast - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

Related studies

Imaging CPT Code Coverage Lookup

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET