Magnetic Resonance Angiography (MRA)
Magnetic Resonance Angiography (MRA) Coverage Summary
Section 1861(s)(2)(C) of the Social Security Act 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 Publication (Pub.) 100-03, the Medicare National Coverage Determinations (NCD) 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 demonstrates the medical necessity of both tests. Prior to June 3, 2010, there was no coverage of MRA outside of the indications and circumstances described in that instruction.
Effective for claims with dates of service on or after June 3, 2010, contractors have the discretion to cover or not cover all indications of MRA (and magnetic resonance imaging (MRI)) that are not specifically nationally covered or nationally non-covered as stated in section 220.2 of the NCD Manual.
Because the status codes for HCPCS codes 71555, 71555-TC, 71555-26, 74185, 74185-TC, and 74185-26 were changed in the Medicare Physician Fee Schedule Database 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.
Effective for claims with dates of service on or after February 24, 201l, Medicare will provide coverage for MRIs for beneficiaries with implanted cardiac pacemakers or implantable cardioverter defibrillators if the beneficiary is enrolled in an approved clinical study under the Coverage with Study Participation form of Coverage with Evidence Development that meets specific criteria per Pub. 100-03, the NCD Manual, chapter 1, section 220.2.C.1.
HCPCS Coding Requirements
Providers must report HCPCS codes when submitting claims for MRA of the chest, abdomen, head, neck or peripheral vessels of lower extremities. The following HCPCS codes should be used to report these services:
MRA Code
MRA of head 70544, 70544-26, 70544-TC
MRA of head 70545, 70545-26, 70545-TC
MRA of head 70546, 70546-26, 70546-TC
MRA of neck 70547, 70547-26, 70547-TC
MRA of neck 70548, 70548-26, 70548-TC
MRA of neck 70549, 70549-26, 70549-TC
MRA of chest 71555, 71555-26, 71555-TC
MRA of pelvis 72198, 72198-26, 72198-TC
MRA of abdomen (dates of service on or after July 1, 2003) – see below. 74185, 74185-26, 74185-TC
MRA of peripheral vessels of lower extremities 73725, 73725-26, 73725-TC
Hospitals subject to OPPS should report the following C codes in place of the above HCPCS codes as follows:
• MRA of chest 71555: C8909 – C8911
• MRA of abdomen 74185: C8900 – C8902
• MRA of peripheral vessels of lower extremities 73725: C8912 – C8914
For claims with dates of service on or after July 1, 2003, coverage under this benefit has been expanded for the use of MRA for diagnosing pathology in the renal or aortoiliac arteries. The following HCPCS code should be used to report this expanded coverage of MRA:
• MRA, pelvis, with or without contrast material(s) 72198, 72198-26, 72198-TC
Hospitals subject to OPPS report the following C codes in place of HCPCS code 72198:
• MRA, pelvis, with or without contrast material(s) 72198: C8918 – C8920
Head and Neck
MRA is effective for evaluating flow in internal carotid vessels of the head and neck. However, not all potential applications of MRA have been shown to be reasonable and necessary. All of the following criteria must apply in order for Medicare to provide coverage for MRA of the head and neck:
* MRA is used to evaluate the carotid arteries, the circle of Willis, the anterior, middle or posterior cerebral arteries, the vertebral or basilar arteries or the venous sinuses.
* MRA is performed on patients with conditions of the head and neck for which surgery is anticipated and may be found to be appropriate based on the MRA. These conditions include, but are not limited to, tumor, aneurysms, vascular malformations, vascular occlusion or thrombosis. Within this broad category of disorders, medical necessity is the underlying determinant of the need for an MRA in specific diseases. The medical records should clearly justify and demonstrate the existence of medical necessity. * MRA and CA are not expected to be performed on the same patient for diagnostic purposes prior to the application of anticipated therapy. Only one of these tests will be covered routinely unless the physician can demonstrate the medical need to perform both tests.
Peripheral Arteries of Lower Extremities MRA of peripheral arteries is useful in determining the presence and extent of peripheral vascular disease in lower extremities. This procedure is non-invasive and has been shown to find occult vessels in some patients for which those vessels were not apparent when CA was performed. Medicare will cover either MRA or CA to evaluate peripheral arteries of the lower extremities.
However, both MRA and CA may be useful in some cases, such as:
* A patient has had CA and this test was unable to identify a viable run-off vessel for bypass.
* When exploratory surgery is not believed to be a reasonable medical course of action for this patient, MRA may be performed to identify the viable runoff vessel.
* A patient has had MRA, but the results are inconclusive.
Abdomen and Pelvis
* Pre-operative Evaluation of Patients Undergoing Elective Abdominal Aortic Aneurysm (AAA) Repair
Effective July 1, 1999, MRA is covered for pre-operative evaluation of patients undergoing elective AAA repair if the scientific evidence reveals MRA is considered comparable to CA in determining the extent of AAA, as well as in evaluating aortoiliac occlusion disease and renal artery pathology that may be necessary in the surgical planning of AAA repair. These studies also reveal that MRA could provide a net benefit to the patient. If preoperative CA is avoided, then patients are not exposed to the risks associated with invasive procedures, contrast media, end-organ damage, or arterial injury.
* Imaging the Renal Arteries and the Aortoiliac Arteries in the Absence of AAA or Aortic Dissection
Effective July 1, 2003, MRA coverage is expanded to include imaging the renal arteries and the aortoiliac arteries in the absence of AAA or aortic dissection. MRA should be obtained in those circumstances in which using MRA is expected to avoid obtaining CA, when physician history, physical examination, and standard assessment tools provide insufficient information for patient management, and obtaining an MRA has a high probability of positively affecting patient management. However, CA may be ordered after obtaining the results of an MRA in those rare instances where medical necessity is demonstrated.
Head and Neck (Procedure codes 70544-70549)
All of the following criteria must apply in order for Medicare to provide coverage for MRA of the head and neck:
a. MRA is used to evaluate the carotid arteries, the circle of Willis, the anterior, middle or posterior cerebral arteries, the vertebral or basilar arteries or the venous sinuses;
b. MRA is performed on patients with conditions of the head and neck for which surgery is anticipated and may be found to be appropriate based on the MRA. These conditions include, but are not limited to, tumor, aneurysms, vascular malformations, vascular occlusion or thrombosis. Within this broad category of disorders, medical necessity is the underlying determinant of the need for an MRA in specific diseases. The medical records should clearly justify and demonstrate the existence of medical necessity; and
c. MRA and contrast angiography (CA) are not expected to be performed on the same patient for diagnostic purposes prior to the application of anticipated therapy. Only one of these tests will be covered routinely unless the physician can demonstrate the medical need to perform both tests.
Chest (procedure codes 71555, C8909, C8910, C8911)
a. Diagnosis of Pulmonary Embolism Patients who are allergic to iodinated contrast material face a high risk of developing complications if they undergo pulmonary angiography or computed tomography angiography. Therefore, Medicare will cover MRA of the chest for diagnosing a suspected pulmonary embolism only when it is contraindicated for the patient to receive intravascular iodinated contrast material.
b. Evaluation of Thoracic Aortic Dissection and Aneurysm Medicare will provide coverage only for MRA or for CA when used as a diagnostic test. However, if both MRA and CA of the chest are used, the physician must demonstrate the medical need for performing these tests. While the intent of this policy is to provide reimbursement for either MRA or CA, CMS is also allowing flexibility for physicians to make appropriate decisions concerning the use of these tests based on the needs of individual patients. Peripheral Arteries of Lower Extremities (procedure codes 73725, C8912, C8913, C8914) Studies have proven that MRA of peripheral arteries is useful in determining the presence and extent of peripheral vascular disease in lower extremities. This procedure is non-invasive and has been shown to find occult vessels in some patients for which those vessels were not apparent when CA was performed. Medicare will cover either MRA or CA to evaluate peripheral arteries of the lower extremities. However, both MRA and CA may be useful is some cases, such as:
a. A patient has had CA and this test was unable to identify a viable run-off vessel for bypass. When exploratory surgery is not believed to be a reasonable medical course of action for this patient, MRA may be performed to identify the viable runoff vessel; or
b. A patient has had MRA, but the results are inconclusive. Abdomen (procedure codes 74185, C8900, C8901, C8902) and Pelvis (procedure codes 72198, C8918, C8919, C8920)
a. Pre-operative Evaluation of Patients Undergoing Elective Abdominal Aortic Aneurysm (AAA) Repair (Effective July 1, 1999) The MRA is covered for pre-operative evaluation of patients undergoing elective AAA repair if the scientific evidence reveals MRA is considered comparable to CA in determining the extent of AAA, as well as in evaluating aortoiliac occlusion disease and renal artery pathology that may be necessary in the surgical planning of AAA repair. These studies also reveal that MRA could provide a net benefit to the patient. If preoperative CA is avoided, then patients are not exposed to the risks associated with invasive procedures, contrast media, end-organ damage, or arterial injury.
b. Imaging the Renal Arteries and the Aortoiliac Arteries in the Absence of AAA or Aortic Dissection (Effective July 1, 2003) The MRA coverage is expanded to include imaging the renal arteries and the aortoiliac arteries in the absence of AAA or aortic dissection. MRA should be obtained in those circumstances in which using MRA is expected to avoid obtaining CA, when physician history, physical examination, and standard assessment tools provide insufficient information for patient management, and obtaining an MRA has a high probability of positively affecting patient management. However, CA may be ordered after obtaining the results of an MRA in those rare instances where medical necessity is demonstrated.
Studies show that diagnostic evaluation of several upper abdominal malignancies may require an evaluation for vascular invasion by the tumor in deciding if the patient is a candidate for surgical resection of the tumor. One example is with pancreatic carcinoma. Pancreatic head carcinomas can grow in close proximity to the superior mesenteric vein.
Evidence suggests that MRA provides reliable, noninvasive evaluation of the portal and hepatic veins. MRA can provide focused evaluation of particular areas of interest as well as a broad overview anatomic display that is helpful to surgeons and interventionalists planning procedures.
CPT/HCPCS Codes
CPT/HCPCS Codes that Support Medical Necessity:
70544 Magnetic resonance angiography, head; without contrast material(s)
70545 with contrast material(s)
70546 without contrast material(s), followed by contrast material(s) and further sequences
70547 Magnetic resonance angiography, neck; without contrast material(s)
70548 with contrast material(s)
70549 without contrast material(s), followed by contrast material(s) and further sequences
71555 Magnetic resonance angiography, chest, (excluding myocardium), with or without contrast material(s)
72198 Magnetic resonance angiography, pelvis, with or without contrast material(s)
73725 Magnetic resonance angiography, lower extremity, with or without contrast material(s)
74185 Magnetic resonance angiography, abdomen, with or without contrast material(sFor hospital OPPS and Ambulatory Surgical Centers (ASCs) only:
For procedure code 71555 Magnetic resonance angiography, chest, (excluding myocardium), with or without contrast material(s) use codes:
C8909 Magnetic resonance angiography with contrast, chest (excluding myocardium)
C8910 Magnetic resonance angiography without contrast, chest (excluding myocardium)
C8911 Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)
For procedure code 72198 Magnetic resonance angiography, pelvis, with or without contrast material(s) use codes:
C8918 Magnetic resonance angiography with contrast, pelvis
C8919 Magnetic resonance angiography without contrast, pelvis
C8920 Magnetic resonance angiography without contrast followed by with contrast, pelvis
For procedure code 73725 Magnetic resonance angiography, lower extremity, with or without contrast material(s) use codes:
C8912 Magnetic resonance angiography with contrast, lower extremity
C8913 Magnetic resonance angiography without contrast, lower extremity
C8914 Magnetic resonance angiography without contrast followed by with contrast, lower extremity
For procedure code 74185 Magnetic resonance angiography, abdomen, with or without contrast material(s) use codes:
C8900 Magnetic resonance angiography with contrast, abdomen
C8901 Magnetic resonance angiography without contrast, abdomen
C8902 Magnetic resonance angiography without contrast followed by with contrast, abdomen
