Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. MRI brain medical necessity not established or conservative treatment not documented
Very Common70551 (MRI brain without contrast) requires documented medical necessity with specific clinical indication. Denied when headaches not severe/persistent enough, when conservative treatment (medications, imaging alternatives) not tried, or when prior imaging not referenced. Simple headache doesn't justify MRI - need red flags: sudden severe headache, neurologic deficits, pattern change, trauma history.
Common Causes
- • Headache documented but no red flags - tension headaches don't require MRI
- • Conservative treatment not attempted - must try medications, lifestyle modifications first
- • No mention of prior CT or other imaging - payers want to see imaging progression
Resolution Strategy
Document red flag features: 'Patient with 6-week history of progressive morning headaches with nausea/vomiting. Failed trial of sumatriptan and prophylactic topiramate over 4 weeks. New neurologic finding: left visual field deficit on confrontation testing. MRI brain ordered to rule out mass lesion, stroke, or increased intracranial pressure.' Must specify: headache pattern (sudden, progressive, worst-ever), duration, failed conservative treatments, neurologic deficits present. If simple tension headache, not medically necessary. Appeal with documentation of concerning features if legitimately present.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For MRI brain without contrast
Common Scenarios
Documentation Requirements
- Indication for MRI brain
- Without contrast
- Findings and interpretation
- Comparison to prior studies if available
- Report documentation
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes MRI brain without contrast
- Includes interpretation and report
- With contrast coded separately
- With and without contrast coded separately
- CT brain coded separately
Exclusions
- 70552 (MRI brain with contrast)
- 70553 (MRI brain without contrast followed by contrast)
- 70450 (CT head or brain without contrast)
- 70540 (MRI orbit, face, and/or neck without contrast)
Coding Notes
Clinical scenarios
- Indication for MRI brain
- Without contrast
- Findings and interpretation
- Indication for MRI brain
- Without contrast
- Findings and interpretation
- Indication for MRI brain
- Without contrast
- Findings and interpretation
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 70551 is the billing code for "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material". For MRI brain without contrast
Medicare pays approximately $193.43 for CPT 70551 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 70551 has a total RVU of 14.26, broken down as: Work RVU 1.60, Practice Expense RVU 12.50, and Malpractice RVU 0.16. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 70551 is "MRI brain medical necessity not established or conservative treatment not documented". 70551 (MRI brain without contrast) requires documented medical necessity with specific clinical indication. Denied when headaches not severe/persistent enough, when conservative treatment (medications, imaging alternatives) not tried, or when prior imaging not referenced. Simple headache doesn't justify MRI - need red flags: sudden severe headache, neurologic deficits, pattern change, trauma history. Common causes include: Headache documented but no red flags - tension headaches don't require MRI; Conservative treatment not attempted - must try medications, lifestyle modifications first. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 70551 include: Indication for MRI brain; Without contrast; Findings and interpretation; Comparison to prior studies if available. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 70551: Includes MRI brain without contrast. Includes interpretation and report Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 70551 include: 26 (Professional component only (interpretation)), TC (Technical component only (equipment/staff)), 59 (Distinct procedural service if performed separately). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 70551 is 30-45 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.