CPT 74712 Fetal MRI Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 74712: Fetal Magnetic Resonance Imaging for Single Gestation

CPT code 74712 covers fetal magnetic resonance imaging for a single gestation to evaluate fetal anatomy and identify developmental abnormalities. Fetal MRI provides detailed multiplanar and three-dimensional views of the fetus, and may include imaging of the placenta and maternal pelvis when clinically indicated. The code is used in prenatal diagnostic pathways when ultrasound findings are inconclusive or further anatomic detail is required.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of clinical context for fetal MRI, common payer coverage considerations, and the types of benchmarks and policy parameters typically associated with advanced prenatal imaging. The publication outlines service definitions, typical sites of service, and operational considerations relevant to radiology and maternal-fetal medicine programs.

This summary provides clinicians, billing managers, and policy analysts with a concise reference to the clinical purpose of fetal MRI under CPT code 74712, the payer landscape covered in the analysis, and the topics addressed in the full publication such as coverage criteria, utilization drivers, and coding practice notes. Data not available in the input is noted where applicable in detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare74712CPTfetal MRIprenatal imagingdiagnostic radiologymaternal-fetal medicineimaging servicesantenatal diagnosis

Billing Code Overview

CPT code 74712 describes fetal magnetic resonance imaging (MRI) performed for a single gestation. The procedure uses magnetic fields and radio waves to generate three-dimensional images of the developing fetus, allowing examination of fetal organs, tissues, and anatomy from multiple angles to identify structural abnormalities. The description notes that imaging may include the placenta and the maternal pelvis as part of the evaluation.

Service type: Diagnostic imaging — fetal MRI

Typical site of service: Hospital outpatient imaging center or dedicated radiology/MRI facility, including tertiary care centers with fetal-maternal medicine and pediatric radiology capabilities.

Clinical & Coding Specifications

Clinical Context

A pregnant patient in the second or third trimester is referred for fetal imaging after an abnormal prenatal ultrasound identifies a possible central nervous system malformation. The patient presents to an outpatient radiology or tertiary perinatal center for a targeted fetal magnetic resonance imaging study. The typical workflow includes pre-procedure review of maternal history and prior ultrasound reports, maternal safety screening for MRI contraindications, obtaining informed consent, and positioning the patient supine or lateral on the MRI table. The MRI technologist acquires multiplanar fetal sequences and may include placental and maternal pelvic sequences. A radiologist with expertise in fetal imaging interprets images and provides a formal report describing fetal anatomy, any anomalies, and implications for perinatal management. The study is commonly scheduled as an outpatient advanced imaging visit and may occur in an ambulatory imaging center or hospital radiology department.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when only the physician interpretation/report is billed separately from technical imaging.
`TC`	Technical component

CPT 74740: Imaging Supervision and Interpretation for Uterine and Fallopian Tube Visualization

CPT-74713-FETAL-MRI-DIAGNOSTIC-IMAGING

CPT 74713: Fetal Magnetic Resonance Imaging

CPT-74775-FEMALE-PERINEUM-IMAGING-SEX-DETERMINATION-DEFORMITY-ASSESSMENT

CPT 74775: Imaging of Female Perineum for Sex or Deformity Assessment

CPT-74742-FALLOPIAN-TUBE-CATHETERIZATION-DIAGNOSTIC-THERAPEUTIC

CPT 74742: Fallopian Tube Catheterization for Diagnosis or Reestablishing Patency

Taxonomy Code	Specialty	Notes
2080P0200X	Diagnostic Radiology	Radiologists interpret fetal MRI studies and provide formal reports.
2080A0400X	Neuroradiology	Neuroradiologists often provide subspecialty interpretation for fetal central nervous system abnormalities.
207Q00000X	Maternal-Fetal Medicine	Maternal-fetal medicine specialists request and utilize fetal MRI findings for perinatal planning.
2086S0123X	Pediatric Radiology	Pediatric radiologists may contribute to interpretation for neonatal prognostication.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q04.3`	Congenital hydrocephalus	Fetal MRI evaluates ventriculomegaly and associated brain malformations.
`Q01.9`	Anencephaly and similar malformations of brain, unspecified	MRI can assess neural tube defects and cranial anomalies not fully defined on ultrasound.
`Q04.8`	Other congenital malformations of brain	Used for a range of fetal CNS anomalies detected or further characterized by MRI.
`O36.593`	Maternal care for suspected fetal abnormality, third trimester	Captures maternal-fetal care encounters when fetal MRI is performed for suspected abnormalities.
`O36.592`	Maternal care for suspected fetal abnormality, second trimester	Used when fetal MRI is obtained during the second trimester for anomaly evaluation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`76811`	Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, limited or follow-up; single or first gestation	Often performed before fetal MRI as the initial screening study prompting MRI for further characterization.
`76805`	Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation; single gestation, first trimester	May be part of prior prenatal imaging in the diagnostic pathway leading to fetal MRI.
`72197`	Magnetic resonance (e.g., MR angiography), any joint, other than specifically listed; without contrast, fetal/placental portions of maternal pelvis (Note: used here as analogous pelvic MRI practice patterns)	Pelvic MRI sequences may be performed during the fetal MRI study to evaluate placenta and maternal pelvis as described in the technique.
`77046`	Magnetic resonance imaging, guidance for interventional procedures (non-specific)	Not routinely paired but listed as related when image guidance or additional MR procedures are required for maternal interventions.
`74181`	Magnetic resonance (e.g., abdominal, pelvic) without contrast, follow-up or related maternal imaging	Maternal abdominal/pelvic MRI codes may be billed for concurrent maternal pelvic imaging when included in the study.

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