Summary & Overview
HCPCS Level II C8904: Breast MRI Without Contrast, Unilateral
HCPCS Level II code C8904 represents a unilateral breast magnetic resonance imaging (MRI) study performed without intravenous contrast. As a targeted diagnostic imaging code, it captures a non-contrast MRI exam focused on one breast and is used in clinical settings for evaluation of specific breast pathology where contrast is not employed or is contraindicated. Nationally, breast MRI coding supports imaging utilization tracking, clinical decision workflows, and claims processing for both commercial and government payers.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The report outlines coverage and billing benchmarks relevant to these payers, where available, and highlights clinical context for use of non-contrast unilateral breast MRI.
Readers will learn: the clinical scope of the code, typical sites of service, payer coverage landscape, and what documentation elements are commonly relevant for claims adjudication. Where specific input data is missing, the summary reflects that those items are not available in the input. This publication is intended to inform coding, revenue cycle, and clinical staff about the role and administrative handling of HCPCS Level II code C8904 in national practice settings.
Billing Code Overview
HCPCS Level II code C8904 describes magnetic resonance imaging without contrast of the breast, unilateral. This service is an imaging procedure performed to evaluate one breast using magnetic resonance imaging (MRI) techniques without the use of intravenous contrast agents.
Service type: Diagnostic imaging — MRI without contrast (breast, unilateral)
Typical site of service: Outpatient imaging center or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A 48-year-old woman with a personal history of atypical ductal hyperplasia and a strong family history of breast cancer is referred for high-resolution imaging of the right breast. The ordering breast surgeon requests a focused magnetic resonance imaging study of the unilateral breast to evaluate an indeterminate mass seen on mammography and diagnostic ultrasound. The outpatient workflow includes scheduling at an MRI-capable imaging center, pre-procedure screening for MRI safety (implants, claustrophobia, renal function if contrast were considered), arrival and consent, placement of a dedicated breast coil, and performance of a non-contrast unilateral breast MRI. Images are acquired and transmitted to the radiologist for interpretation, with a formal report documenting lesion size, location, morphology, and recommendations for additional imaging or biopsy. Results are communicated back to the referring provider (e.g., breast surgeon or medical oncologist) for management planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
51 | Multiple procedures | When multiple distinct procedures are billed on the same day and payer requires modifier for secondary procedures |
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