Summary & Overview
CPT 70552: MRI of Brain and Brain Stem With Contrast
CPT code 70552 represents a contrast-enhanced magnetic resonance imaging (MRI) study of the brain and brain stem. This diagnostic imaging code is frequently used in evaluating neurological symptoms, suspected intracranial lesions, inflammatory and infectious conditions, and when enhanced visualization of vascular and soft-tissue detail is required. Nationally, contrast MRI exams are key components of neuroimaging pathways and influence utilization, outpatient imaging capacity, and payer coverage policy.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and typical sites of service, common modifiers and billing considerations, and a summary of payer coverage patterns where available. The publication also highlights benchmarks and utilization context relevant to radiology and neurology service lines.
This report provides clinicians, billing staff, and policy analysts with concise reference material on coding practice for contrast-enhanced brain MRI, expected service settings, and the payer landscape. Data not available in the input is noted where applicable. The goal is to clarify the code's clinical purpose and the administrative considerations that commonly accompany billing for this MRI study.
Billing Code Overview
CPT code 70552 describes the use of magnetic resonance imaging (MRI) of the brain and brain stem with contrast. This service involves administering an intravenous contrast agent to enhance visualization of intracranial structures and pathology.
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Service type: Diagnostic imaging (contrast-enhanced MRI of brain and brain stem)
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Typical site of service: Outpatient radiology departments, hospital imaging centers, and freestanding MRI facilities
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Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents to the outpatient imaging center with new-onset severe headaches, intermittent dizziness, and a recent episode of transient right-sided weakness. Neurologic examination raises concern for a central nervous system lesion. The ordering neurologist requests a contrast-enhanced brain MRI to evaluate for intracranial mass, metastasis, stroke-related changes, or inflammatory disease. The patient arrives fasting per center protocol, is screened for contraindications to gadolinium contrast (renal function, prior contrast reactions, implanted devices), and completes pre-procedure consent. The MRI technologist performs an intravenous contrast injection and acquires multiplanar, contrast-enhanced sequences of the brain and brainstem. The radiologist interprets the study, issues a finalized report documenting findings and comparison to prior studies if available, and communicates urgent actionable results to the referring provider. Typical workflow includes scheduling by the clinic or imaging service, pre-scan screening, contrast administration, image acquisition (usually 30–60 minutes total), interpretation, and report distribution to the ordering clinician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the radiologist’s interpretation (professional component) separate from technical facility charge |