Summary & Overview

HCPCS C8933: Magnetic Resonance Angiography, Spinal Canal Without and With Contrast

HCPCS Level II code C8933 represents a magnetic resonance angiography (MRA) procedure of the spinal canal and contents performed first without contrast and then with IV contrast. This paired-sequence MRA is used to evaluate vascular anatomy and pathology within the spinal canal, including vascular malformations and blood flow abnormalities, and is relevant to neurology, neurosurgery, and interventional radiology workflows. Nationally, such advanced imaging codes matter because they affect care pathways, utilization patterns, and payer coverage determinations for high-cost diagnostic studies.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what C8933 denotes, typical sites of service, common billing modifiers (listed elsewhere), and the clinical context for using combined non-contrast and contrast MRA of the spine. The publication also highlights benchmarks and policy-relevant considerations such as utilization drivers, documentation expectations, and coding precision needed for payer adjudication. Where input data is incomplete, the report notes unavailable elements and focuses on nationally applicable guidance, coding interpretation, and operational implications for imaging providers and billing teams.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC8933HCPCS Level IIMagnetic Resonance AngiographySpinal ImagingDiagnostic RadiologyOutpatient ImagingContrast Administration

Billing Code Overview

HCPCS Level II code C8933 describes magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents. The service type is advanced diagnostic imaging using magnetic resonance angiography (MRA) procedures performed both without and then with intravenous contrast to evaluate the spinal canal and its contents. The typical site of service for this procedure is an outpatient radiology/imaging center or hospital outpatient department, where MRI/MRA equipment and contrast administration capabilities are available.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting with progressive lower extremity numbness, radicular back pain, or neurologic deficits suggesting spinal cord or nerve root compression. The patient may have a prior history of degenerative spine disease, prior spine surgery, suspected vascular malformation of the spinal canal, spinal tumor, trauma, or signs of myelopathy. After initial clinical evaluation and plain radiographs or non-contrast MRI, the ordering clinician requests a comprehensive magnetic resonance angiography (MRA) of the spinal canal and contents performed without intravenous contrast followed by a separate acquisition with contrast to evaluate both non-vascular and vascular anatomy.

The clinical workflow: the patient is scheduled in the radiology department for a combined non-contrast and contrast-enhanced spine MRA. Pre-procedure screening verifies MRI safety, renal function (e.g., estimated glomerular filtration rate) when gadolinium is planned, and informed consent. Non-contrast sequences (including time-of-flight or other flow-sensitive techniques) are obtained first to assess baseline anatomy and flow phenomena; intravenous gadolinium is then administered and post-contrast angiographic sequences are acquired to better delineate vascular malformations, tumor enhancement, inflammatory or neoplastic processes, and epidural venous plexus abnormalities. Radiology documents both the non-contrast and contrast phases, any complications, and provides a combined interpreted report. Billing uses HCPCS Level II code C8933 for the combined study; applicable modifiers are appended per payer and circumstance, and correlation with diagnostic ICD-10 codes for spinal cord compression, vascular lesions, tumors, or trauma is included on the claim.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard service	Used when no special circumstance or modifier applies to the procedure.
`22`	Increased procedural services	When the study requires substantially greater resources or time than usual due to complexity (e.g., extensive sequences, difficult patient positioning).
`23`	Unusual anesthesia	When general or deep sedation/anesthesia is medically necessary for the MRI and is unrelated to the procedure itself.
`26`	Professional component	When billing only the interpreting physician’s professional component for the MRA interpretation separate from technical facility charges.
`51`	Multiple procedures	When multiple distinct imaging procedures are performed on the same day and payer requires identification of multiple procedure situation.
`52`	Reduced services	When the study is partially reduced or not completed for clinical reasons but still reportable.
`53`	Discontinued procedure	When the exam is started but discontinued due to patient condition or safety concerns.
`62`	Two surgeons	Rarely applicable but used if two qualified physicians of different specialties are required for the imaging-guided procedure component.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist service	When an advanced practice clinician provides an allowable portion of the professional service under state law and payer policy.
`QX`	CRNA service with medical direction by physician	When a certified registered nurse anesthetist provides anesthesia services under medical direction for MRI in payers that track CRNA-direction status.
`QY`	Medical direction of CRNA by physician	When the physician medically directs a CRNA for the anesthesia provided during the MRI.
`TC`	Technical component	When billing only the technical component (facility or equipment usage and technologist time) of the MRA separate from interpretation.

Taxonomy Code	Specialty	Notes
`2085P0200X`	Diagnostic Radiology	Most common specialty ordering and interpreting spinal MRA studies.
`2086S0102X`	Neuroradiology	Subspecialists who frequently interpret complex spinal vascular and intradural lesions.
`207RC0000X`	Orthopedic Surgery (Spine)	Surgeons who order the study for preoperative planning and assessment of degenerative/traumatic spine disease.
`207L00000X`	Neurological Surgery	Neurosurgeons who use MRA for evaluation of spinal cord lesions, vascular malformations, and surgical planning.
`2084N0400X`	Emergency Medicine	Emergency physicians who may request urgent spinal MRA for acute neurologic deficit or trauma in coordination with radiology.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M48.06`	Spinal stenosis, lumbar region	Lumbar spinal stenosis can compress nerve roots and the spinal canal; MRA may be used to evaluate vascular contributors or to assess soft tissue and venous structures.
`M47.12`	Other spondylosis with radiculopathy, lumbar region	Degenerative changes with radiculopathy prompting imaging to evaluate foraminal and canal compromise; contrast can help identify inflammatory or neoplastic enhancement.
`G95.9`	Disease of spinal cord, unspecified	Non-specific spinal cord disease where combined non-contrast and contrast imaging helps differentiate etiologies, including vascular lesions.
`I67.6`	Nonpyogenic thrombosis of intracranial venous system	While intracranial, analogous venous thrombosis or epidural venous plexus abnormalities affecting the spinal canal may necessitate angiographic assessment.
`D32.1`	Benign neoplasm of spinal meninges	Spinal meningiomas and other intradural extramedullary tumors often require contrast-enhanced sequences to delineate lesion extent and vascularity.
`S14.109A`	Unspecified injury of cervical spinal cord, initial encounter	Acute traumatic spinal cord injury where angiographic sequences may be indicated to evaluate vascular injury or perfusion-related issues.
`M50.20`	Other cervical disc displacement, unspecified cervical region	Disc disease with radiculopathy or myelopathy where comprehensive MRI (with and without contrast) helps differentiate disc pathology from other enhancing lesions.
`Q28.2`	Arteriovenous malformation of cerebral vessels (includes spinal vascular malformations by analogy)	Spinal arteriovenous malformations and fistulae are key indications for contrast-enhanced MRA to identify feeding vessels and plan intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`72156`	Magnetic resonance imaging, spinal canal and contents, lumbar; without contrast material followed by with contrast material and further sequences	A closely related CPT study for lumbar spine MRI performed both without and with contrast — used when payer requires CPT rather than HCPCS Level II coding for comprehensive MRI of the lumbar spine.
`72158`	Magnetic resonance imaging, spinal canal and contents, lumbar; with and without contrast material, enhancement and further sequences	Alternative CPT descriptor for combined non-contrast and contrast-enhanced lumbar spine MRI — used in coding workflow when CPT mapping is required.
`72141`	Magnetic resonance imaging, spinal canal and contents, cervical; without contrast material followed by with contrast material and further sequences	Cervical spine equivalent when the study targets the cervical spinal canal and contents in this two-phase approach.
`72142`	Magnetic resonance imaging, spinal canal and contents, cervical; with and without contrast material, enhancement and further sequences	Alternative cervical spine CPT descriptor used in coding crosswalks.
`70498`	Magnetic resonance angiography, head, without and with contrast material, including non-contrast and contrast sequences when performed	Not a spine code but represents MRA protocol structure; occasionally referenced for protocol similarities and technical guidance when developing spine MRA sequences.
`77012`	Computed tomography guidance for spinal procedures (example)	Represents other imaging-guided procedures that may be performed in the same episode of care (e.g., CT-guided spine injections) and billed separately; listed as commonly associated services in complex spine evaluations.