“Brain MRI with contrast” is specific enough to code. However, it could leave the coder to ask, “were there any non-contrast images performed?”
When contrast is administered to a patient, images are performed both before and after the contrast is administered. The codes 70552 and 70553 indicate the imaging performed after the contrast is administered. The code 70552 is assigned when a computed tomography (CT) scan is performed and code 70553 is assigned when a magnetic resonance (MR) imaging is performed. So, when the description provided only states the type of imaging performed, it does not indicate if the imaging was with or without contrast, and therefore, the claim submitted may not represent the imaging performed by the provider.
One Injection, Two Possible Codes
The presence of contrast does not tell you whether to report 70552 or 70553. Both involve contrast-enhanced imaging. The difference is whether a dedicated non-contrast phase was also performed.
| CPT code | Brain MRI examination | Documentation to confirm |
|---|---|---|
| 70551 | Without contrast | A completed non-contrast study |
| 70552 | With contrast only | Contrast-enhanced imaging without a dedicated pre-contrast phase |
| 70553 | Without contrast, followed by contrast and further sequences | Both imaging phases within the combined examination |
These brain MRI codes include the brainstem. They are not interchangeable descriptions of the same scan.
Select 70552 for a contrast-only examination
A report that contains only a brain MRI with contrast may support 70552. Without additional information, we cannot make this determination.
Review the adequacy of the other records. If the other records support contrast, and there are images prior to the contrast and additional sequences done after the contrast was administered, this would be considered an examination in the with contrast and without contrast category.
Choose code 70553 when finished with both phases of the examination
The code 70553 represents the MRI of the brain with and without contrast. This code represents the overall service and should not be sub-divided to represent the individual phases of the service.
An MRI scanner produces images in sequences. The number of sequences acquired during an exam does not allow for the conclusion that additional procedures have been performed. Acquiring additional sequences during the same examination does not provide a basis for charging for additional examinations.
Select 70551 when the study is completed without contrast
An order may request both non-contrast and contrast phases of the study. However, the final interpretation of the study may vary.
If contrast is withheld and a complete non-contrast brain MRI is obtained and interpreted, 70551 represents the service. Interpreting a non-contrast brain MRI, in the absence of the contrast, would not support performing a brain MRI with contrast.
Read the Record in the Right Order
Review the supporting documents, then go back to complete the examination.
The radiology report states the name of the requested exam. The contrast study record confirms when the contrast was ordered and given. The order states the rationale for the requested exam, and the authorization states when the insurance company approved the exam.
Each document answers a different question.
First, establish the performed protocol
Review the report’s technique section for:
- The anatomy examined.
- Whether non-contrast imaging was acquired.
- Whether contrast was administered.
- Whether post-contrast sequences were completed.
- Any limitations or interruption of the examination.
Do not infer the protocol from the findings alone. A report can describe an abnormality without clearly explaining how the examination was performed.
Next, reconcile contrast administration
For each of the contrast administration recordings reviewed, verify the name of the contrast agent, the volume administered, and the route of administration in the appropriate version of the patient’s record.
In the case of a discrepancy, the administration record should not be relied upon to justify the expected contrast charge.
The opposite approach should be taken when contrast is documented on the administration record, and the technique section is lacking.
Finally, examine the order and authorization
When a request to change the order of a service is approved, that does not signify that the existing order code also needs to be changed.
first determine if the modification to the protocol is valid under the requirements for ordering the service. Then, determine if the change to the service also requires a corresponding change to the authorization.
It is not appropriate to change the service order code to reflect an approval number.
Three Situations That Commonly Lead to Wrong Claims
These hypothetical examples illustrate coding decisions. They are not instructions for choosing a patient’s imaging protocol.
The scheduler enters “with contrast,” but both phases are performed
The description for the scheduled MRI says “MRI brain with contrast.” However, the report says the MRI was done with contrast, and describes several sequences that were performed with and after the contrast administration.
The examination supports code 70553. Scheduling may suggest code 70552.
Correct differentiation of contrast-only studies from with-and-without studies should occur in both the scheduling and charge review processes.
The patient declines contrast after non-contrast imaging
The exam comprises of the 2 phases, and the patient refuses the injection. The interpreter performs a review of the non contrast images.
The completed service supports 70551. Justify the change and satisfy any pertinent authorization requirements.
It is unnecessary to use 70553 with a reduced service modifier in conjunction with 70551 to denote incomplete service when 70551 describes the completed examination.
The report does not establish whether both phases occurred
The charge is entered as 70553, and the technique section just says “MRI brain performed.”
This is a documentation issue and does not give any information about what level was performed or if both levels were done.
It is advised to request documentation clarification prior to payment of the claim.
Review the adequacy of the service provided, based on the description of the service performed, and apply the corresponding reduced or discontinued service rules. If the service was discontinued, apply the service discontinuation rules.
Why A Diagnosis Code Cannot Replace Clinical Documentation
Documenting medical necessity for a particular service is separate from selecting the correct code to represent that service.
The code for a particular service describes only the service itself; it neither implies nor suggests the rationale for the service.
There are many situations in which clinical documentation may be needed to support the request for a particular service, such as documentation outlining the status of a patient’s neurological function and/or symptomatology, the patient’s relevant medical history and/or prior neurological examinations/imaging, and the rationale and R/V/P/T status for requesting the service.
Documentation of the rationale for a requested service is necessary, and copying the diagnosis on the claim will not satisfy this need.
Don’t code a suspected condition as a confirmed diagnosis
For outpatient services, a brain tumor evaluation should not result in a code for cancer.
When a diagnosis is not made, report the signs and/or symptoms for which the patient was being evaluated. When a diagnosis is made based on a radiology report, code according to the radiology report.
If a patient is being evaluated for an intracranial lesion (tumor) due to persistent headaches, and the condition is not yet cancer, the coding and billing staff should not assign a code for cancer.
Support the specifics of the case record
Diagnoses assigned to the highest level of detail supported by the case record should be assigned. Other details that may also be documented should be considered for assignment.
A coverage list should not be considered a checklist for reporting diagnoses.
Normal studies do not imply the requested study was medically unnecessary. The indication for the requested study should be considered.
Prior Authorization Has More Than One Moving Part
An authorization number can be valid while the claim still falls outside its approved scope.
Before the examination, confirm:
- The patient’s exact insurance product.
- Whether authorization is required for the procedure and setting.
- The approved service or CPT code.
- The imaging location and relevant provider information.
- The authorization’s validity period.
- Any limits on the number of services.
- The payer’s process for protocol changes.
An approval associated with 70551 should not be assumed to cover 70553. Some plans allow specified substitutions or updates; others require additional review.
Prevent protocol changes from becoming patient billing issues.
Always inform authorization staff of any changes to the planned examination.
Inform the staff the procedure for verifying payer requirements and procedures for submitting additional information.
After a scan has been performed, do not report a non-contrast examination if the authorization was for a non-contrast examination and documentation shows both phases of the examination were performed. Contact the payer to resolve the authorization issue.
Distinguish authorization from payment conditions.
Not allpayment questions are answered with authorization.
There are other payment related conditions that still need to be considered such as eligibility, network, benefits, and restriction, as well as the accuracy of the claim. The conditions of authorization may assist in providing partial payment but may not provide all the information necessary to answer all of the conditions for payment.
Medicare and Commercial Plans: Avoid Blanket Rules
The same MRI code can pass through different coverage and payment processes depending on the patient’s plan.
Original Medicare
Find the national requirements for coverage of MRI services and contractor direction, if available.
Coverage of the service is determined by a local coverage document (LCD). LCDs are specific to geographical areas.
When coverage of an implanted medical device is in question, further review will be necessary. A statement in the record, “patient has an implant,” does not determine coverage or non-coverage of the service.
Medicare Advantage and private insurance
Make sure you check the precise plan requirements even if the plan is administered by a company you’re already familiar with.
Differences in rules and guidelines regarding things like network boundaries and medical necessity can vary by product, even if the product is offered by the same company.
Ideally, a payer resource guide would be available that has helpful information in locating specific requirements and exceptions. Staff should not relay general statements like “Any brain MRIs require prior authorization.” or “We don’t need to get prior authorization for this insurer.”
Professional, Technical, or Global: Bill the Portion You Furnished
The procedure code identifies the MRI examination. Component billing identifies which part of that service the entity is reporting.
| Service being billed | Typical reporting on a professional claim |
|---|---|
| Interpretation and written report | MRI code with modifier 26 |
| Technical component | MRI code with modifier TC |
| Both components, when eligible for global billing | MRI code without 26 or TC |
Do not make the decision based only on who owns the scanner. Confirm the services furnished, billing rights, and applicable arrangements.
Hospital institutional claims follow their own reporting rules. A technical-component example for a freestanding imaging center should not be copied onto every hospital claim.
For patients, this distinction can explain why an MRI generates separate facility and radiologist charges. Separate bills are not necessarily duplicates, but each should represent a distinct component or service.
Contrast Charges Need Their Own Review
Brain MRI contrast billing involves two questions that are often confused:
- Can the contrast agent be reported?
- Is its administration separately reportable?
Complete the appropriate HCPCS code and unit definition for the product administered. Do not automatically select an unspecified contrast code. A product-specific code and unit definition should be assigned when applicable.
Support for the submitted units must be documented. Assumptions regarding the unit of measurement for agents administered should not be made. A 50 mL vial of contrast does not always mean a 50 mL dose was administered.
There are differences in payment policies by payer and in the types of services provided. A supply reported as administered by one practitioner may not always result in payment for that service.
Pursuant to Medicare’s hospital imaging rules, the administration of contrast for an MRI and the routine vascular access are considered integral to the service and are not reportable separately. Therefore, a charge for contrast should not result in an additional charge for the injection.
Another Report Does Not Automatically Mean Another Procedure
A brain MRI and an MRA answer different diagnostic questions, but separate report titles alone do not establish separately billable studies.
For Medicare reporting, distinguish:
- Two separate, medically necessary technical studies.
- One technical acquisition used to generate both MRI and MRA reports.
They will not allow reporting of both procedures simply because there are two reports.
Modifier 59 or an X modifier should not be added to the code-pair edit and documentation to indicate a service was separate, unless there is a clear explanation for the service being distinct. A modifier does not describe and justify overlapping service as two separate services.
Additional imaging sequences to clarify image quality do not substantiate that the imaging was a repeat examination. A valid and sufficient rationale supported by documentation would describe and justify a repeat examination.
Match the Denial Response to the Actual Problem
Changing a modifier is not a universal remedy for an unpaid MRI claim.
Read the payer’s adjustment reason and accompanying remarks, then identify the issue before deciding how to respond.
| Claim issue | Review before taking action |
|---|---|
| Wrong contrast category | Completed protocol, report, and administration record |
| Authorization discrepancy | Approved service, location, validity, and substitution rules |
| Missing documentation | Specific information needed and the appropriate clarification process |
| Medical-necessity denial | Documented indication and applicable coverage requirements |
| Duplicate billing | Previously submitted professional, technical, or global components |
| Bundled imaging | Actual technical studies, code-pair edits, and distinct-service support |
| Contrast quantity mismatch | Product, administered amount, and billing-unit calculation |
Choose the response that fits: corrected claim, requested documentation, reconsideration, or appeal.
Track recurring issues by payer and cause. If several claims fail because the technique section is incomplete, the lasting fix may be a documentation workflow change rather than another round of appeals.
Frequently Asked Questions From Coders and Patients
Does “MRI brain w/wo contrast” mean CPT 70553?
It describes the planned with-and-without protocol. Report 70553 when the completed examination and documentation support non-contrast imaging followed by contrast and additional sequences.
Can I bill 70552 whenever contrast is administered?
No. Contrast administration occurs in both 70552 and 70553 examinations. The presence or absence of the dedicated pre-contrast phase determines which description fits.
Can 70551 and 70552 replace 70553 on the same claim?
Not when they represent the two phases of one combined examination. Use the combined code rather than splitting that service into separate parts.
Does a pituitary or IAC MRI always use 70553?
No. The protocol name alone does not establish contrast status or separate billability. Review the anatomy, completed examination, documentation, and applicable coding instructions.
Will the CPT code tell me how much the MRI costs?
No. The provider’s charge, insurer’s allowed amount, and patient’s responsibility are different figures. Request an estimate that identifies the expected procedure, imaging location, and whether interpretation and other services are included.
Can an authorized MRI claim still be denied?
Yes. Authorization does not resolve every eligibility, benefit, network, documentation, or claim-submission requirement. Review the denial’s specific reason rather than assuming the approval guarantees payment.
Before the Claim Leaves Your Queue
A final review should answer these seven questions:
- Does the code match the completed examination? Distinguish 70551, 70552, and 70553.
- Do the records agree? Resolve conflicts involving the order, technique, and contrast administration.
- Is the diagnosis supported? Report established findings or the appropriate reason for the encounter.
- Does the authorization fit? Confirm the approved service, location, validity, and any allowed changes.
- Are you billing the correct component? Check professional, technical, or eligible global reporting.
- Are additional charges justified? Validate contrast units and any separately reported imaging.
- Are unresolved questions on hold? Clarify them before submission instead of relying on an assumption.
If a reviewer cannot connect a claim line to the documented service, that line is not ready to leave the queue.
