When billing for neuroimaging services in the U.S., accurately using the right CPT (Current Procedural Terminology) code is critical. Mistakes can lead to claim denials, audits, or underpayment. One of the more common areas of confusion involves MRI of the brain. This article will walk you through the latest codes, guidelines, documentation essentials, and pitfalls to avoid.
We’ll cover:
- The standard MRI brain CPT codes
- When to use contrast, or both contrast and non-contrast
- Documentation & modifier rules
- Payer (Medicare, private insurer) nuances
- Common errors and audit traps
Let’s get started.
What Are CPT Codes?
CPT codes are a standardized set of numerical codes published by the American Medical Association. They are used to describe medical, surgical, and diagnostic services for billing and administrative purposes in the U.S.
Using the correct CPT ensures the provider gets reimbursed properly and supports compliance with payer guidelines.
In radiology, there are many codes for MRIs depending on body region, contrast usage, and whether additional sequences (like angiography) are included.
MRI Brain — Core CPT Codes
In most clinical settings, three main CPT codes are used for MRI of the brain (head) imaging:
| CPT Code | Description | When to Use |
|---|---|---|
| 70551 | MRI Brain without contrast | Use when contrast is not needed or contraindicated |
| 70552 | MRI Brain with contrast | Use when the study is done only with contrast (rare for brain-only unless specific indication) |
| 70553 | MRI Brain without and with contrast | Use when both noncontrast and contrast phases are included in the exam |
Some supplementary codes may apply if additional sequences are done (e.g. MRA, MRV) but the above are the base brain MRI codes.
Additional related codes
- 70544 — MRV Head without contrast (venography)
- 70545 — MRA Brain with contrast
- 70546 — MRA Brain without and with contrast
These often are bundled or combined with the base CPT (e.g. 70553) depending on reporting practices and payer policies.
Choosing the Right Code: Contrast or No Contrast?
The decision to use contrast, noncontrast, or both is clinical. Here are key considerations:
- Indication / Clinical Question
- Some suspected pathologies (e.g. tumor, infection, vascular lesions) benefit from contrast enhancement to highlight breakdown of the blood-brain barrier.
- Routine follow-up of stable conditions or evaluation of demyelinating disease might use noncontrast only.
- Contraindications / Patient Safety
- Patients with impaired kidney function may not tolerate gadolinium contrast well.
- Allergies or past adverse reactions are also considerations.
- Payer & Coverage Rules
- Some insurers or Medicare may require justification for use of contrast, especially if both contrast and noncontrast phases are included.
- If contrast is not justified or documented, the payer may downgrade or deny the “with contrast” portion.
- Institutional Protocols
- Some sites adopt a baseline noncontrast plus contrast protocol for many brain MRIs, and default code is 70553.
- Others may restrict contrast usage to certain indications.
Thus, knowing the clinical justification and documenting appropriately is as important as selecting the CPT.
Documentation Requirements & Modifiers
Accurate documentation ensures you can support the CPT code chosen if audited. Here are key elements:
- Clinical indication / reason for study
Must clearly describe why MRI is being done (e.g. new-onset seizure, headache with red flags, suspected tumor). - Contrast status
Document whether contrast was used or not, and why (if used). - Specific sequences and findings
Report which sequences were done (e.g. T1, T2, FLAIR, DWI, post-contrast). - Any complications or deviations
If contrast was withheld due to patient factors, document the reason.
Modifiers
Occasionally, modifiers may apply:
- Modifier 52 (Reduced services): If a contrast dose was reduced or exam was partially limited, this may apply.
- Modifier 59 / XU / XE / XS / XP: If you report additional distinct procedures that might otherwise bundle, check payer rules for the appropriate modifier to indicate distinct, separate procedure.
But modifiers should be used carefully and only when supported by documentation and payer policy.
Medicare & Payer-Specific Issues
When billing Medicare or private insurers, keep in mind:
- Medical Necessity
Imaging must meet accepted standards of care in terms of indication. For instance, Medicare often reviews requests to ensure imaging isn’t overutilized. - Bundling & Global Payment Issues
Some advanced sequences (e.g. MR angiography) may be bundled under the base brain MRI CPT, depending on payer. - Local Coverage Determinations (LCDs)
In some regions, Medicare contractors issue LCDs that specify when MRI of the brain (and use of contrast) is covered. - Preauthorization / Prior Authorization
Some private insurers require preauthorization for contrast MRI studies of the brain, especially those with both contrast and noncontrast phases.
Always cross-check with the specific payer’s radiology or imaging policy.
Common Errors and Audit Traps
Mistakes in coding or documentation can lead to denials or audits. Watch out for:
- Using 70553 by default without justification
If contrast is not clinically warranted or documented, using the “both” code may raise flags. - Failing to document contrast rationale
You must clearly state why contrast was used (or why it was withheld). - Not listing sequences / technical details
A generic “MRI brain done” is insufficient; auditors expect the specifics. - Incorrect use of modifiers
Modifiers must be used correctly and only when supported by documentation. - Billing overlapping exams
If multiple imaging studies on same day or region overlap, payers may combine or deny.
Practical Example
Scenario A:
A patient presents with new-onset seizure. The radiologist orders an MRI brain with and without contrast to look for a focal lesion. The correct CPT code is 70553. Documentation should include the indication (seizure), contrast plan, sequences done, and findings.
Scenario B:
A patient with known multiple sclerosis is undergoing routine surveillance imaging. Contrast is not needed. Use 70551, and document the chronic nature of the disease, rationale for noncontrast, and sequences.
Tips & Best Practices
- Always align imaging request with clinical indication.
- Review payer policies before contrast-enhanced exams.
- Use structured reporting templates that capture sequence details, contrast usage, and justification.
- Periodically audit your own imaging claims to detect overuse of 70553 or incorrect codes.
- Educate referring physicians so their order requests include justification for contrast use.
Summary
- The core CPT codes for MRI brain are 70551 (no contrast), 70552 (contrast only), and 70553 (both noncontrast and contrast)
- Choosing the right code depends on clinical need, patient safety, and payer rules.
- Proper documentation and use of modifiers are crucial to support billing.
- Be aware of payer-specific rules, audits, and coverage limitations.