Summary & Overview
HCPCS C8906: Magnetic Resonance Imaging with Contrast, Bilateral Breasts
HCPCS Level II code C8906 denotes a bilateral magnetic resonance imaging (MRI) study of the breasts performed with intravenous contrast. Breast MRI with contrast is an important diagnostic tool nationally for detecting occult malignancy, assessing extent of known cancer, and clarifying findings from mammography or ultrasound. The procedure is typically performed in outpatient imaging centers and hospital outpatient radiology departments and has implications for diagnostic pathways and utilization management across payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks for coverage and utilization, an overview of relevant clinical context for bilateral contrast-enhanced breast MRI, and summaries of payer policy themes that commonly affect prior authorization, medical necessity criteria, and site-of-service determinations. The publication also highlights coding considerations tied to bilateral breast imaging and typical documentation elements that support coverage decisions. Data not available in the input is noted where specific payer policies, reimbursement rates, or associated taxonomies and ICD-10 codes would normally appear.
Billing Code Overview
HCPCS Level II code C8906 describes magnetic resonance imaging with contrast of the breasts, performed bilaterally. This service represents an MRI study using intravenous contrast to evaluate both breasts for diagnostic indications such as cancer detection, extent of disease, or problem-solving when other imaging is inconclusive.
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Service type: Diagnostic breast MRI with contrast, bilateral
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Typical site of service: Outpatient imaging center or hospital outpatient radiology department
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman referred for diagnostic breast magnetic resonance imaging with intravenous contrast for evaluation of suspected multicentric breast cancer detected on mammography and ultrasound, assessment of extent of disease after a new core biopsy-proven malignancy, or problem-solving for inconclusive prior imaging. The clinical workflow begins with the ordering clinician documenting the indication (for example, extent of disease, implant evaluation, high-risk screening with known BRCA mutation, or evaluation of postoperative recurrence). Intake includes screening for MRI safety (implants, prior surgeries, renal function for gadolinium-based contrast agent), pregnancy status, and contrast allergy history. The patient is positioned prone on a dedicated breast coil, an IV is placed for gadolinium contrast, and bilateral dynamic contrast-enhanced sequences are obtained with pre- and post-contrast sequences and subtraction imaging. The study is interpreted by a board-certified radiologist with mammography/breast imaging training, who issues a report with BI-RADS assessment and recommendations for follow-up or biopsy if indicated. Typical site of service is an outpatient radiology department or ambulatory imaging center; the service type is diagnostic imaging (magnetic resonance imaging) of the breasts performed with contrast, bilateral. Common scenario modifiers include documentation for technical component vs professional component billing and modifiers for outpatient vs ambulatory surgical center or facility-specific reporting when applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |