Summary & Overview
CPT 70551: MRI of the Brain Without Contrast
CPT code 70551 is a widely utilized billing code for magnetic resonance imaging (MRI) of the brain, performed without the use of contrast material. This diagnostic radiology procedure is essential for evaluating a range of neurological conditions, including headaches, vertigo, epilepsy, and cerebrovascular diseases. The code is recognized nationally and is covered by major payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, reflecting its importance in both clinical and reimbursement contexts.
This publication provides a comprehensive overview of 70551, including payer coverage, clinical indications, and related billing codes. Readers will gain insight into the typical sites of service, such as hospital outpatient departments and imaging centers, and understand the role of this procedure in the broader landscape of diagnostic imaging for the head and neck. The summary also highlights relevant modifiers and associated taxonomies, offering clarity on billing practices and policy updates. Benchmarks and clinical context are discussed to inform stakeholders about utilization trends and regulatory considerations. The information is presented for a national audience, supporting healthcare professionals, administrators, and policy analysts in navigating the complexities of medical billing and coverage for brain MRI procedures.
CPT Code Overview
CPT code 70551 represents magnetic resonance imaging (MRI) of the brain (including brain stem) without contrast material. This procedure is a key diagnostic radiology service used to evaluate neurological conditions and abnormalities within the brain. It is commonly performed in advanced imaging facilities, such as hospital outpatient departments or dedicated imaging centers. The service is part of the broader category of Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck, providing clinicians with detailed images to support diagnosis and treatment planning.
Clinical & Coding Specifications
Clinical Context
A patient presents to an advanced imaging facility, such as a hospital outpatient department or imaging center, with symptoms including persistent headache, episodes of vertigo, or unexplained neurological changes. The ordering physician, often a neurologist or primary care provider, requests a magnetic resonance imaging (MRI) of the brain without contrast to evaluate for possible structural abnormalities, cerebrovascular disease, or seizure disorders. The procedure is performed by a radiologist specializing in diagnostic radiology, neuroradiology, or pediatric radiology, depending on the patient's age and clinical presentation. The MRI is used to assess the brain and brain stem for conditions such as epilepsy, cerebrovascular disease, or other unspecified brain disorders.
Coding Specifications
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Modifiers:
GA: Waiver of Liability Statement Issued as Required by Payer Policy (expectation of denial; ABN on file)GX: Notice of Liability Issued, Voluntary Under Payer PolicyGZ: Item or service expected to be denied as not reasonable and necessary; no ABN on file
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Provider Taxonomies:
2085R0202X: Radiology, Diagnostic Radiology2085N0700X: Radiology, Neuroradiology