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CPT 73221: MRI arm joint (shoulder, elbow or wrist) without contrast - Prior Authorization and Price

CPT code 73221 is MRI arm joint (shoulder, elbow or wrist) without contrast. See what Aetna, Anthem BCBS, Cigna, Medicare, UnitedHealthcare look for before approving it, the conditions their guidelines cover, and what it typically costs.

CPT 73221

Imaging the upper extremity joint using MRI without any contrast.

MRI Arm & Shoulder
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Payer guidelines that apply

PayerReviewed usingGuidelineSections
Aetna eviCore
Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026
Pediatric Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026
 14 that name this code
Anthem BCBS Carelon
Imaging of the extremities effective Sep 19, 2026
Oncologic imaging effective Apr 4, 2026
 32 that name this code
Cigna eviCore
Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026
Pediatric Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026
 14 that name this code
Medicare CMS 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 14 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 MRI arm joint (shoulder, elbow or wrist) without contrast. Each has its own criteria for when the study is considered appropriate.

  • Post-Operative Follow-Up Aetna · Cigna · UnitedHealthcare
  • Arthritis and Joint Degeneration Aetna · Cigna · UnitedHealthcare
  • Capsular/Synovial and Meniscal Dysfunction 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
  • Ligament and Fascia Injury Aetna · Cigna · UnitedHealthcare
  • Muscle/Tendon Unit Injuries/Diseases Aetna · Cigna · UnitedHealthcare
  • Osteonecrosis/Avascular Necrosis Aetna · Cigna · UnitedHealthcare
  • Brachial Plexus Aetna · Cigna · UnitedHealthcare
  • Focal Neuropathy Aetna · Cigna · UnitedHealthcare
  • Acute traumatic injuries –not otherwise specified Anthem BCBS
  • Adhesive capsulitis (Adult only) Anthem BCBS
  • Avascular necrosis Anthem BCBS
  • Biceps or triceps tendon rupture Anthem BCBS
  • Brachial plexopathy Anthem BCBS
  • Brachial plexus mass Anthem BCBS
  • Cancer screening, not otherwise specified Anthem BCBS
  • Capitellar osteochondritis 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
  • Magnetic Resonance Imaging Medicare
  • 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

Plus 5 more. Use the search below to find a specific condition.

Typical price

Commercial insurance, median
$1,109
Middle half of rates: $536 to $2,152
Medicare, hospital outpatient
$244
Facility payment
Medicare, physician fee schedule
$206
National, non-facility

Commercial figures come from negotiated rates published by 1,051 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 MRI arm joint (shoulder, elbow or wrist) without contrast change.

Frequently asked questions

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