CPT Code for MRI of the Sacrum
For an MRI of the sacrum, use CPT code 72195 (MRI pelvis without contrast) or 72197 (MRI pelvis with and without contrast), depending on whether contrast is administered.
Coding Rationale
The sacrum is anatomically part of the pelvis, and there is no separate, dedicated CPT code specifically for "MRI sacrum." The appropriate billing approach depends on the clinical indication and contrast use:
Without Contrast
- CPT 72195: MRI pelvis without contrast
- This is the standard code when imaging the sacrum/sacroiliac joints without IV gadolinium
- Appropriate for most sacral pathology evaluations 1
With and Without Contrast
- CPT 72197: MRI pelvis without and with contrast
- Used when contrast enhancement is clinically indicated
- May be appropriate for suspected inflammatory sacroiliitis when contrast helps identify inflammatory changes 1
With Contrast Only
- CPT 72196: MRI pelvis with contrast (without pre-contrast sequences)
- Rarely used in isolation for sacral imaging
Clinical Context from Guidelines
The ACR Appropriateness Criteria provide guidance on when MRI of the sacroiliac joints/sacrum is indicated:
- Initial evaluation of suspected spondyloarthropathy: X-rays are first-line (rating 9), with MRI rated as "usually not appropriate" (rating 1) initially 1
- After negative/equivocal radiographs: MRI sacroiliac joints becomes "usually appropriate" (rating 8), with or without contrast both rated equally 1
- Contrast use: May be helpful for identifying inflammatory changes, but MRI without contrast is considered a reasonable alternative 1
Important Coding Considerations
- The anatomic coverage of "MRI pelvis" includes the sacrum and sacroiliac joints
- Documentation should specify the clinical indication and anatomic region of interest
- If dedicated sacroiliac joint sequences are performed, this still falls under the pelvis CPT codes
- Do not use spine codes (lumbar spine codes 72148-72158) for isolated sacral imaging, as the sacrum is coded as part of the pelvis, not the spine