Summary & Overview
HCPCS C8905: Unilateral Breast MRI Without then With Contrast
HCPCS Level II code C8905 denotes a unilateral breast magnetic resonance imaging (MRI) exam performed without contrast followed by with contrast. This combined non-contrast and contrast MRI sequence is used in diagnostic evaluation of breast pathology, surgical planning, and surveillance when detailed tissue characterization is required. As an imaging-specific HCPCS Level II code, C8905 is relevant for payers, radiology practices, and outpatient imaging facilities because it defines billing for a distinct MRI protocol that may have different coverage rules and medical necessity criteria compared with single-phase MRI studies.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for the service, typical sites of service, and what to expect in payer coverage assessment. The publication outlines benchmark elements and common policy considerations affecting reimbursement and authorization for breast MRI services, highlights billing and coding implications for combined non-contrast/contrast protocols, and summarizes where to look for payer-specific policy updates and documentation requirements. Data not available in the input for payer-specific rates or utilization statistics.
Billing Code Overview
HCPCS Level II code C8905 describes magnetic resonance imaging performed without contrast followed by with contrast of the breast, unilateral. This service involves sequential MRI acquisition of a single breast first without intravenous contrast and then with contrast administration to evaluate breast tissue.
-
Service type: Diagnostic imaging (breast MRI with and without contrast)
-
Typical site of service: Ambulatory imaging centers or hospital outpatient departments
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 48-year-old woman with a suspicious finding on diagnostic mammography and focal asymmetry on ultrasound is referred for a targeted breast magnetic resonance imaging study. The order specifies a unilateral study of the left breast to further characterize an indeterminate 1.8 cm enhancing lesion seen on prior imaging, and to assess extent of disease preoperatively. The clinical workflow includes preauthorization when required by the payor, screening for MRI contraindications (implants, pacemaker, renal function for gadolinium if indicated), intravenous access for contrast, patient positioning in the breast coil, acquisition of non-contrast sequences followed immediately by dynamic post-contrast sequences, radiologist interpretation with BI-RADS assessment, and generation of a report that documents indication, laterality, sequences performed (without and with contrast), findings, and comparison to prior imaging. Imaging technologist documents contrast agent name and dose in the imaging record. If biopsy is indicated, the radiologist communicates recommendations to the ordering clinician for next steps.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when the billing is for the interpreting physician only; technical component billed separately. |
TC |