Procedure code and description
70540 – Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) -average fee amount– $360 – $370
70542 – Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s)
70543 – Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences
| MRI and MRA’s | Procedure code |
| MRI spine screening to include 3 separate codes |
72146, 74141 72148 |
| MRA abdomen; with or w/o contrast | 74185 |
| MRA carotid w/o contrast | 70547 |
| MRA carotid with contrast | 70548 |
| MRA chest; with or w/o contrast | 71555 |
| MRA head; w/o contrast | 70544 |
| MRA head; w/o contrast followed by contrast |
70546 |
| MRA head; with contrast | 70545 |
| MRA pelvis; with or w/o contrast | 72198 |
| MRA peripheral runoff | 73725, 72198 74185 |
| MRA spinal canal & contents; with or w/o contrast |
72159 |
| MRA upper extremity; with or w/o contrast |
73225 |
| MRI abdomen; w/o contrast | 74181 |
| MRI abdomen; w/o contrast followed by with contrast |
74183 |
| MRI abdomen; with contrast | 74182 |
| MRI brain; w/o contrast | 70551 |
| MRI brain; w/o contrast followed by contrast |
70553 |
| MRI brain; with contrast | 70552 |
| MRI breast; bilateral | 77059 |
| MRI breast; unilateral | 77058 |
| MRI cardiac for morphology and function w/o contrast |
75557 |
| MRI cardiac for morphology and function w/o contrast and with contrast |
75561 |
| MRI cardiac velocity flow map | 75565 |
| MRI cervical spine; w/o contrast | 72141 |
| MRI cervical spine; w/o contrast followed by contrast |
72156 |
| MRI cervical spine; with contrast | 72142 |
| MRI chest; w/o contrast | 71550 |
| MRI chest; w/o contrast followed by with contrast |
71552 |
| MRI chest; with contrast | 71551 |
| MRI Etris DVT Research scan; scan involves both CPT codes |
73718, 72198 |
| MRI fetal | 76498 |
| MRI lower extremity, any joint w/o contrast |
73721 |
| MRI lower extremity, any joint w/o contrast followed by with contrast |
73723 |
| MRI lower extremity, any joint with contrast |
73722 |
| MRI lower extremity, other than joint w/o contrast |
73720 |
| MRI lower extremity, other than joint with contrast |
73719 |
| MRI lower extremity, other than joint/o contrast |
73718 |
| MRI lumbar spine; w/o contrast | 72148 |
| MRI lumbar spine; w/o contrast followed by contrast |
72158 |
| MRI lumbar spine; with contrast | 72149 |
| MRI orbit, face and neck; w/o contrast |
70540 |
| MRI orbit, face and neck; w/o contrast followed by with contrast |
70543 |
| MRI orbit, face and neck; with contrast |
70542 |
| MRI pelvis; w/o contrast | 72195 |
| MRI pelvis; w/o contrast followed by contrast |
72197 |
| MRI pelvis; with contrast | 72196 |
| MRI temporomandibular joint(s) | 70336 |
| MRI thoracic spine w/o contrast followed by contrast |
72157 |
| MRI thoracic spine; w/o contrast | 72146 |
| MRI thoracic spine; with contrast | 72147 |
| MRI upper extremity, any joint w/o contrast |
73221 |
| MRI upper extremity, any joint w/o contrast followed by with contrast |
73223 |
| MRI upper extremity, any joint with contrast |
73222 |
| MRI upper extremity, other than joint w/o contrast |
73218 |
| MRI upper extremity, other than joint w/o contrast followed by with contrast |
73220 |
| MRI upper extremity, other than joint with contrast |
73219 |
| MRI pelvis; w/o contrast | 72195 |
| MRI pelvis; w/o contrast followed by contrast |
72197 |
| MRI pelvis; with contrast | 72196 |
| MRI temporomandibular joint(s) | 70336 |
| MRI thoracic spine w/o contrast followed by contrast |
72157 |
| Infant upper extremity minimum 2 views |
73092 |
what is the cpt code for mri foot ?
CPT 73718 – Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)
CPT 73719 – Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s)
CPT 73720 – Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences
how often mri can be done ?
A new MRI can be indicated every 2–5 years and more frequent imaging is especially recommended for younger patients with progressive disease.
Depending on the size of the area being scanned and the number of images being taken
what is the cpt code for mri enterography?
There are no CPT codes for these procedures, as there is no defined technique. If the technique only documents the abdomen and if we believe that the pelvis is also done, then we need to get a confirmation with the radiologist for clarification.
how often does medicare pay for mri ?
Yes, Medicare pays for the MRI based on the “Medically necessary” and ordered by the provider.
how often can cpt 77336 be billed ?
Once every consecutive five treatments are delivered. This frequency should match the weekly radiation treatments billed. It is specific to the review of the weekly radiation treatment plan whole body mri scan cpt code
There is no specific CPT code for whole body MRI scan and so we can use an unlisted code 76498.
Medicare coverage and limitation
Magnetic Resonance Imaging (MRI) is a noninvasive diagnostic imaging modality used to diagnose a variety of central nervous system disorders. MRI provides superior tissue contrast when compared to CT, is able to image in multiple planes, is not affected by bone artifact, provides vascular imaging capability, and makes use of safer contrast media (gadolinium chelate agents). Its major disadvantage over CT is the longer scanning time required for study, making it less useful for emergency evaluations. Contraindications include patients with cardiac pacemakers, implanted neurostimulators, cochlear implants, metal in the eye and older ferromagnetic intracranial aneurysm clips. All of these may be potentially displaced when exposed to the powerful magnetic fields used in MRI.
MRI of the Orbit, Face, and/or Neck will be considered medically reasonable and necessary when used to diagnose and characterize pathology of the nasopharynx, oropharynx, and neck including tumors, infection, soft tissue pathologies, and congenital abnormalities.
The MRI is not covered when the following patient-specific contraindications are present:
•MRI is not covered for patients with cardiac pacemakers or with metallic clips on vascular aneurysms unless the Medicare beneficiary meets the provisions of the following exceptions:
Effective for claims with dates of service on or after July 7, 2011, the contraindications will not apply to pacemakers when used according to the FDA-approved labeling in an MRI environment, or effective for claims with dates of service on or after February 24, 2011, CMS believes that the evidence is promising although not yet convincing that MRI will improve patient health outcomes if certain safeguards are in place to ensure that the exposure of the device to an MRI environment adversely affects neither the interpretation of the MRI result nor the proper functioning of the implanted device itself. We believe that specific precautions (as listed below) could maximize benefits of MRI exposure for beneficiaries enrolled in clinical trials designed to assess the utility and safety of MRI exposure. Therefore, CMS determines that MRI will be covered by Medicare when provided in a clinical study under section 1862(a)(1)(E) (consistent with section 1142 of the Act) through the Coverage with Study Participation (CSP) form of Coverage with Evidence Development (CED) if the study meets the criteria in each of the three paragraphs in CMS Pub 100-03, CMS National Coverage Determination Manual, Chapter 1, Section 220.2.C.1
•MRI during a viable pregnancy is also contraindicated at this time.
•The danger inherent in bringing ferromagnetic materials within range of MRI units generally constrains the use of MRI on acutely ill patients requiring life support systems and monitoring devices that employ ferromagnetic materials.
•In addition, the long imaging time and the enclosed position of the patient may result in claustrophobia, making patients who have a history of claustrophobia unsuitable candidates for MRI procedures.
Nationally Non-Covered Indications:
CMS has determined that MRI of cortical bone and calcifications, and procedures involving spatial resolution of bone and calcifications, are not considered reasonable and necessary indications within the meaning of section 1862(a)(1)(A) of the Act, and are therefore non-covered.
When Magnetic Resonance Imaging is used for an investigational purpose, an acceptable advance notice of denial of payment must be given to the patient when the provider does not want to accept financial responsibility for the service.
In some instances, MRI of the brain, as well as MRI of the orbit, face, and/or neck may be medically necessary on the same day. The medical record should document the medical necessity for these two procedures being performed on the same day.
Initial imaging of the thyroid should be done with ultrasound or nuclear medicine, unless there is a known carcinoma present.
This policy addresses standard CT and MR imaging. Magnetic Resonance Angiography (MRA) is not addressed in this policy.
Computerized Tomography (CT)
Computerized tomography (CT scanning) uses the attenuation of an x-ray beam by an object in its path to create cross-sectional images. As x-rays pass through planes of the body, the photons are detected and recorded as they exit from different angles. Computers process the signals to produce a cross-sectional view of the body. The signal data may be subjected to a variety of post-acquisitional processing algorithms to obtain a multiplanar view of the anatomy.
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI) is a non-invasive diagnostic scanning technique that employs a powerful and highly uniform static magnetic field, rather than ionizing radiation, to produce images. Fluctuations in the strength of the magnetic field alter the motion and relaxation times of hydrogen molecules, which are related to the density of molecules and reflect the physicochemical properties of the tissues. Reconstructed images can be displayed in multiple planes to facilitate analysis. See national non-coverage in CMS section above.
Coverage is limited to those CT and MRI machines that have received pre-market approval by the FDA. Such units must be operated within the parameters specified by the approval.
Medicare coverage for CT scans is allowed provided the service is medically reasonable and necessary.
Inconclusive findings on a CT scan may warrant a MRI study and, conversely, findings of a MRI study may be further clarified (under certain circumstances) with a subsequent CT scan. The information provided by the two modalities may be complementary.
Cancer Staging. Clinicians commonly use CT and MRI of the brain when metastatic involvement is suspected.
Non-covered indications: esophagus, oropharynx, and prostate, and non-melanoma skin cancer in the absence of symptoms of brain involvement. “Certain tumors almost never metastasize to the brain parenchyma. These include carcinomas of the esophagus, oropharynx, and prostate, and non-melanoma skin cancers.” (DeVita, Chapter 52.1) Accordingly, the related diagnoses found in the following diagnosis code list do not justify brain scans for “staging” purposes unless a patient has signs or symptoms suggesting brain involvement. Covered: In contrast, for those malignancies that commonly metastasize to the brain, staging in the absence of neurological findings may be appropriate.
Payment will be allowed for reasonable and necessary scans of different areas of the body that are performed on the same day.