Magnetic Resonance Angiography Coverage Summary
Provides for coverage of diagnostic testing. Coverage of magnetic resonance angiography (MRA) of the head and neck, and MRA of the peripheral vessels of the lower extremities is limited as described in the Medicare National Coverage Determinations Manual. This instruction has been revised as of July 1, 2003, based on a determination that coverage is reasonable and necessary in additional circumstances. Under that instruction, MRA is generally covered only to the extent that it is used as a substitute for contrast angiography, except to the extent that there are documented circumstances consistent with that instruction that demonstrate the medical necessity of both tests. There is no coverage of MRA outside of the indications and circumstances described in that instruction.
Because the status codes for HCPCS codes 71555, 71555-TC, 71555-26, 74185, 74185-TC, and 74185-26 were changed in the MPFSDB from N to R on April 1, 1998, any MRA claims with those HCPCS codes with dates of service between April 1, 1998, and June 30, 1999, are to be processed according to the contractor’s discretionary authority to determine payment in the absence of national policy.
For claims submitted to the carrier or Part B MAC: Physicians, non-physician professionals and other providers submitting claims to the carrier should use the following CPT codes to bill MRA services:
** MRA of chest – 71555
** MRA of abdomen – 74185
** MRA of peripheral vessels of lower extremities – 73725 ** MRA of pelvis – 72198
** MRA of head and neck – 70544, 70545, 70546, 70547, 70548, 70549
ICD-9-CM diagnosis code V82.9 (Special screening of other conditions, unspecified condition) should be used to indicate a screening test performed in the absence of a diagnosis of a specific sign, symptom, or complaint. Provider should be aware of the multiple procedure reduction of the technical component (TC) component of certain diagnostic imaging procedures, effective January 1, 2006. (Refer to Pub. 100-04, Medicare Claims
Processing Manual, Transmittal 732, CR 4034.) The diagnosis code(s) must best describe the patient’s condition for which the service was performed. Claims for Magnetic Resonance Angiography (MRA) services are payable under Medicare Part B in the following places of service: ** The global or technical components are payable in office (11) and independent clinic (49). ** The professional component is payable in office (11), inpatient hospital (21), outpatient hospital (22), or emergency room (23).