Q9954 Oral MRI Contrast | HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS Q9954: Oral Magnetic Resonance Contrast Agent, per 100 ml

HCPCS Level II code Q9954 designates an oral magnetic resonance contrast agent, billed per 100 ml, used to improve visualization of the gastrointestinal tract on MRI. As an imaging contrast supply code, Q9954 matters nationally because it affects imaging procedure supply costs, prior authorization practices, and billing clarity for radiology providers and payers across commercial and government plans.

Key payers included in the assessment are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of where Q9954 fits in MRI imaging workflows, typical sites of service, and how payers commonly handle coverage and billing for contrast agents. The publication summarizes benchmarks for utilization and reimbursement where available, highlights policy considerations such as coding granularity and per-volume billing, and provides clinical context about the agent’s role in gastrointestinal MRI protocols.

This national-level summary is intended for billing managers, radiology administrators, and policy analysts seeking clear, actionable reference material on HCPCS Level II code Q9954, including how it is reported and the types of settings where it is used. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ9954HCPCS Level IIMRI contrastoral contrastradiologyimaging suppliesoutpatient imagingdiagnostic radiology

Billing Code Overview

HCPCS Level II code Q9954 is an oral magnetic resonance contrast agent billed per 100 ml. This code represents a contrast medium administered orally to enhance magnetic resonance imaging (MRI) of the gastrointestinal tract.

Service type: Diagnostic contrast agent for MRI

Typical site of service: Outpatient radiology departments, imaging centers, and hospital outpatient departments

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with a history of known or suspected gastrointestinal pathology (for example, small-bowel Crohn disease or obscure GI bleeding) is referred for an abdominal or pelvic magnetic resonance imaging (MRI) study that requires an oral negative/positive enteric contrast agent to opacify the bowel lumen and improve lesion detection. In the radiology workflow the patient receives the Q9954 oral magnetic resonance contrast agent (dosage measured per 100 ml) in the imaging preparation area approximately 30–60 minutes before scanning, with the technologist documenting volume administered and lot number. The MRI technologist and radiologist coordinate timing and sequences (enteric-distention protocols, T1- and T2-weighted and post-contrast sequences) to optimize visualization. The typical site of service is an outpatient imaging center or hospital outpatient department where MRI studies are performed under supervision of a radiologist. Pre-procedure screening for contraindications to MRI and review of allergies is completed during intake. Nursing or technologist staff may administer the oral agent; the radiologist interprets the study and documents the use of oral MR contrast in the report for coding and billing using Q9954 per 100 ml unit(s).

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier.

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Taxonomy Code	Specialty	Notes
`2085R0200X`	Diagnostic Radiology	Radiologists interpret MR studies and direct contrast use protocols.
`2084P0800X`	Nuclear Medicine / Radiology hybrid	Radiologists with cross-training in imaging contrast protocols may be involved.
`174400000X`	Nurse Practitioner	May perform intake, screening, and administration of oral contrast under protocol.
`363A00000X`	Radiology Technologist	Performs patient preparation, administers oral contrast, and executes MR protocols.
`2086S0125X`	Interventional Radiology	May be involved when MR enterography is part of a complex diagnostic workup.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K50.00`	Crohn disease of small intestine without complications	Oral MR contrast improves small-bowel distention and detection of active inflammation and strictures.
`K52.2`	Allergic and dietetic gastroenteritis and colitis	Used when MRI enterography is performed to evaluate inflammatory causes of abdominal pain.
`K57.30`	Diverticulitis of large intestine without perforation or abscess	MR enterography can help evaluate complicated diverticular disease when CT is contraindicated.
`R10.9`	Unspecified abdominal pain	Common presenting symptom prompting cross-sectional imaging with oral MR contrast to evaluate causes.
`K92.1`	Melena	Occult GI bleeding workup may include MR enterography with oral contrast when indicated.
`C78.7`	Secondary malignant neoplasm of liver and intrahepatic bile duct	MR with oral enteric contrast assists in lesion characterization and local staging in select cases.
`Z98.890`	Other specified postprocedural states	Prior surgeries altering bowel anatomy may necessitate oral MR contrast to delineate anatomy during imaging.
`K55.9`	Vascular disorder of intestine, unspecified	MR enterography can be part of evaluation for ischemic or vascular-related intestinal pathology.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`73721`	Magnetic resonance imaging, any joint of lower extremity; without contrast material, followed by contrast and further sequences	Related when MR enterography sequences are combined with contrast-enhanced sequences for the abdomen/pelvis protocol.
`74181`	Magnetic resonance imaging, abdomen; without contrast material	Used when non-contrast abdominal MRI sequences are performed prior to enteric contrast-enhanced sequences.
`74183`	Magnetic resonance imaging, abdomen; with contrast material(s) and further sequences	Commonly performed with oral MR enteric contrast to evaluate abdominal pathology with IV contrast.
`74263`	Radiologic examination, contrast, gastrointestinal tract; small intestine (enteroclysis, small-bowel follow-through) — note: radiographic code often considered in differential workflows	May be performed in alternative imaging pathways when MR enterography is not used; relevant to workflow planning.
`76377`	3D rendering with interpretation and reporting of CT, MRI, or ultrasound data	Sometimes performed adjunctively when advanced 3D post-processing of MR data is required after oral contrast administration.

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