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70552

Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s)

Radiology MRI 15.48 Total RVUs
Quick Reference
For MRI brain with contrast

Relative Value Units (RVUs)

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Work RVU
1.80
Physician effort
PE RVU
13.50
Practice expense
MP RVU
0.18
Malpractice
Total RVU
15.48
Combined value
Dollar reimbursement rates vary by locality and payer. RVUs shown for relative comparison only.
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Clinical Information

When to Use

For MRI brain with contrast

Time Requirement
40-55 minutes typical procedure time

Common Scenarios

Enhancing brain lesion evaluation
Brain tumor evaluation
Infection evaluation
Contrast-enhanced brain imaging
Vascular evaluation

Documentation Requirements

  • Indication for MRI brain
  • With contrast
  • Contrast type and amount
  • Findings and interpretation
  • Report documentation

Coding Guidelines

Common Modifiers

26 Professional component only (interpretation)
TC Technical component only (equipment/staff)
59 Distinct procedural service if performed separately

Bundling Rules

  • Includes MRI brain with contrast
  • Includes interpretation and report
  • Without contrast coded separately
  • With and without contrast coded separately
  • CT brain coded separately

Exclusions

  • 70551 (MRI brain without contrast)
  • 70553 (MRI brain without contrast followed by contrast)
  • 70460 (CT head or brain with contrast)
  • 70540 (MRI orbit, face, and/or neck without contrast)

Coding Notes

No global period - diagnostic procedure
With contrast only
Professional and technical components may be separate
Document indication and findings

Clinical scenarios

Enhancing brain lesion evaluation
Enhancing brain lesion evaluation
When to use:For MRI brain with contrast
  • Indication for MRI brain
  • With contrast
  • Contrast type and amount
Brain tumor evaluation
Brain tumor evaluation
When to use:For MRI brain with contrast
  • Indication for MRI brain
  • With contrast
  • Contrast type and amount
Infection evaluation
Infection evaluation
When to use:For MRI brain with contrast
  • Indication for MRI brain
  • With contrast
  • Contrast type and amount

Who are you?

Code Details

Code 70552
Category Radiology
Subcategory MRI
Total RVUs 15.48

Medicare Pricing

PFS
2025 National Rate
$266.54
Facility
$266.54
Non-Facility
$266.54
RVU Breakdown
Work RVU:1.78PE RVU:6.35MP RVU:0.11Total RVU:8.24CF:$32.3465Global Days:XXX
OPPS Details
APC:5572Status:Q3Copayment:
Physician Fee Schedule: Medicare pays physicians based on Relative Value Units (RVUs) multiplied by a conversion factor.

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Frequently Asked Questions

What is CPT code 70552?

CPT 70552 is the billing code for "Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s)". For MRI brain with contrast

How much does Medicare pay for CPT 70552?

Medicare pays approximately $266.54 for CPT 70552 (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.

What are the RVUs for CPT 70552?

CPT 70552 has a total RVU of 15.48, broken down as: Work RVU 1.80, Practice Expense RVU 13.50, and Malpractice RVU 0.18. RVUs (Relative Value Units) determine Medicare reimbursement rates.

What documentation is required for CPT 70552?

Key documentation requirements for CPT 70552 include: Indication for MRI brain; With contrast; Contrast type and amount; Findings and interpretation. Missing or incomplete documentation is a leading cause of claim denials for this code.

Can CPT 70552 be billed with other codes?

Bundling considerations for CPT 70552: Includes MRI brain with contrast. Includes interpretation and report Use an NCCI bundling checker to verify specific code combinations before billing.

What modifiers are commonly used with CPT 70552?

Common modifiers for CPT 70552 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.

What is the time requirement for CPT 70552?

The typical time requirement for CPT 70552 is 40-55 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.

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