CPT 70558: Intraoperative Contrast-Enhanced MRI of Brain, During Open Surgery - OpenPayer

Summary & Overview

CPT 70558: Intraoperative Contrast-Enhanced MRI of Brain, During Open Surgery

CPT code 70558 denotes an intraoperative, contrast-enhanced magnetic resonance imaging (MRI) study of the brain, including the brain stem and skull base, performed during open cranial surgery to assess for residual tumor or vascular malformation. This code captures advanced imaging delivered in the operative setting and is clinically significant for guiding immediate surgical decision-making and reducing the need for reoperation.

Key national payers commonly referenced for coverage and payment practice include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for use of this intraoperative MRI service, typical sites of care, and payer coverage themes. The publication outlines billing and coding considerations, common modifiers encountered, and where to find relevant clinical rationale for intraoperative imaging.

This summary equips clinicians, billing professionals, and policy analysts with the context needed to interpret claims that include 70558, understand typical operational settings for the service, and locate further benchmark and policy detail. Data not available in the input is noted where relevant in subsequent sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 70558intraoperative MRIbrain imagingneurosurgerycontrast MRIoperative imagingsurgical imagingmedical billing

Billing Code Overview

CPT code 70558 describes an intraoperative magnetic resonance imaging (MRI) study of the brain, including the brain stem and skull base, performed during open cranial surgery. The service is performed with contrast material and is intended to evaluate for residual tumor or residual vascular malformation while the patient remains in the operative setting.

Service type: Intraoperative contrast-enhanced MRI of the brain during open cranial surgery
Typical site of service: Operating room / intraoperative surgical suite (performed during open brain surgery)

Clinical & Coding Specifications

Clinical Context

A 56-year-old patient undergoes craniotomy for resection of a suspected intracranial neoplasm located near the skull base. Intraoperative magnetic resonance imaging (70558) with intravenous contrast is performed in the operating room after tumor debulking to evaluate for residual tumor tissue and to guide further resection while the patient remains anesthetized. The workflow includes coordination between the neurosurgeon, anesthesia, and an intraoperative MRI technologist/neuroradiologist: sterile field management and MRI safety checks are completed, contrast (gadolinium-based agent) is administered per protocol, images are acquired and reviewed in real time by the surgeon and radiologist, and decisions about further resection are made based on the findings. Typical perioperative documentation includes the indication for intraoperative MRI, time and dose of contrast, sequences obtained, intraoperative findings (residual tumor or vascular malformation), and any immediate complications or delays related to imaging.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the professional component (interpretation) of the MRI if technical component billed separately.
`TC`

CPT 70557: Intraoperative Non-Contrast Brain MRI Including Brain Stem and Skull Base

cpt-70371-pharyngeal-speech-cineradiography-video-evaluation

CPT 70371: Pharyngeal and Speech Evaluation by Cineradiography/Video

cpt-70552-mri-brain-brain-stem-with-contrast

CPT 70552: MRI of Brain and Brain Stem With Contrast

cpt-70010-posterior-cranial-fossa-contrast-imaging-interpretation

CPT 70010: Posterior Cranial Fossa Contrast Imaging Interpretation

cpt-70480-ct-orbit-sella-posterior-fossa-ear-non-contrast

CPT 70480: CT of Orbit, Sella/Posterior Fossa, or Ear, Non-Contrast

cpt-70355-panoramic-jaw-radiograph-fracture-evaluation

CPT 70355: Panoramic Jaw Radiograph for Fracture Evaluation

cpt-70543-mri-orbits-face-neck-with-and-without-contrast

CPT 70543: MRI of Orbits, Face, and Neck with and without Contrast

cpt-70240-sella-turcica-x-ray-pituitary-assessment

CPT 70240: Sella Turcica X‑ray to Assess Pituitary Gland for Tumor

cpt-70555-functional-mri-brain

CPT 70555: Functional MRI of the Brain

cpt-70370-pharynx-larynx-fluoroscopic-exam-swallowing-breathing

CPT 70370: Fluoroscopic/Magnified Exam of Pharynx and Larynx

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Taxonomy Code	Specialty	Notes
207RC0000X	Neurological Surgery	Primary specialty performing craniotomy and intraoperative MRI guidance.
207T00000X	Radiation Oncology	May be involved for intraoperative imaging in tumor cases for planning, limited role.
2084P0800X	Diagnostic Radiology	Radiologist interprets intraoperative MRI images and documents findings.
2086S0102X	Neuroradiology	Subspecialist providing interpretation and protocol selection for intraoperative brain MRI.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C71.9`	Malignant neoplasm of brain, unspecified	Common primary diagnosis prompting craniotomy and intraoperative MRI to assess extent of tumor resection.
`C72.5`	Malignant neoplasm of cerebellum and brainstem	Tumors near skull base/brainstem often require intraoperative imaging to confirm resection margins.
`D33.4`	Benign neoplasm of brainstem	Benign intrinsic lesions where intraoperative MRI assists in maximizing safe resection.
`Q28.2`	Arteriovenous malformation of cerebral vessels	Vascular malformations may be evaluated intraoperatively by MRI to check for residual nidus after resection.
`I69.398`	Sequelae of other cerebrovascular disease, other part of brain	Post-vascular lesion management where intraoperative imaging can help evaluate residual anatomical abnormalities.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`70558`	Magnetic resonance imaging, brain, including brain stem and skull base, intraoperative, with contrast	Primary intraoperative MRI service used to evaluate residual tumor or vascular malformation during open cranial surgery.
`61790`	Stereotactic radiosurgery, multiple sessions or single session (complex intracranial procedures vary)	May be performed later in the treatment course for residual tumor identified on intraoperative MRI; complementary therapy.
`61510`	Craniectomy or craniotomy for excision of brain tumor, supratentorial or infratentorial; initial	The operative procedure during which intraoperative MRI is performed; documents the surgical resection.
`70553`	MRI brain without contrast followed by contrast and further sequences	Preoperative or postoperative MRI protocol often used in diagnostic workup and follow-up, complementary to the intraoperative `70558`.
`77046`	Magnetic resonance guidance for interventional procedure	Related technology when MRI guidance is used intraoperatively for targeting; adjunctive to `70558`.

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