Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. MRI brain with and without contrast not medically necessary - non-contrast study may suffice
Common70553 (MRI brain with and without contrast) requires specific indication where both non-contrast and post-contrast sequences necessary. Denied when simpler study adequate (70551 non-contrast for many headaches, 70552 with contrast only for known tumor), when indication doesn't justify dual study, or when prior imaging sufficient. Typical indications: characterizing brain lesion, evaluating pituitary adenoma, acoustic neuroma workup, brain tumor surveillance.
Common Causes
- • Headache evaluation - typically 70551 (without contrast) sufficient
- • Known brain lesion but with-and-without not necessary - post-contrast only may suffice
- • No documented lesion to characterize - screening doesn't require contrast
Resolution Strategy
Document specific need for dual sequences: 'Patient with newly identified 2.3cm heterogeneous mass right frontal lobe on outside hospital CT. MRI brain with and without contrast ordered to characterize lesion. Non-contrast sequences assess for hemorrhage, calcification, and intrinsic T1/T2 characteristics. Post-contrast sequences evaluate enhancement pattern to differentiate primary brain tumor, metastasis, abscess, or vascular malformation. Dual study necessary for complete lesion characterization and surgical planning.' Must specify: known lesion requiring characterization, why both non-contrast and post-contrast necessary, how it changes management. If simple headache, use 70551. If known enhancing tumor follow-up, 70552 may suffice. Appeal only if dual study genuinely needed for diagnosis.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For MRI brain without contrast followed by contrast
Common Scenarios
Documentation Requirements
- Indication for MRI brain
- Without contrast followed by contrast
- Contrast type and amount
- Findings and interpretation
- Report documentation
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes MRI brain with and without contrast
- Includes interpretation and report
- Without contrast only coded separately
- With contrast only coded separately
- CT brain coded separately
Exclusions
- 70551 (MRI brain without contrast)
- 70552 (MRI brain with contrast)
- 70470 (CT head or brain without contrast followed by contrast)
- 70540 (MRI orbit, face, and/or neck without contrast)
Coding Notes
Clinical scenarios
- Indication for MRI brain
- Without contrast followed by contrast
- Contrast type and amount
- Indication for MRI brain
- Without contrast followed by contrast
- Contrast type and amount
- Indication for MRI brain
- Without contrast followed by contrast
- Contrast type and amount
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 70553 is the billing code for "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences". For MRI brain without contrast followed by contrast
Medicare pays approximately $314.08 for CPT 70553 (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 70553 has a total RVU of 17.92, broken down as: Work RVU 2.20, Practice Expense RVU 15.50, and Malpractice RVU 0.22. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 70553 is "MRI brain with and without contrast not medically necessary - non-contrast study may suffice". 70553 (MRI brain with and without contrast) requires specific indication where both non-contrast and post-contrast sequences necessary. Denied when simpler study adequate (70551 non-contrast for many headaches, 70552 with contrast only for known tumor), when indication doesn't justify dual study, or when prior imaging sufficient. Typical indications: characterizing brain lesion, evaluating pituitary adenoma, acoustic neuroma workup, brain tumor surveillance. Common causes include: Headache evaluation - typically 70551 (without contrast) sufficient; Known brain lesion but with-and-without not necessary - post-contrast only may suffice. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 70553 include: Indication for MRI brain; Without contrast followed by contrast; Contrast type and amount; Findings and interpretation. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 70553: Includes MRI brain with and without contrast. Includes interpretation and report Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 70553 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 70553 is 50-70 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.