CPT® Code 70553

Quick Reference: CPT 70553

• Definition: MRI of Brain (including brain stem) performed without contrast followed by with contrast in one session.
• Bundling Rule: Includes 70551 (Non-contrast) and 70552 (Contrast only). Do not bill these separately.
• Contrast: Typically Gadolinium-based. Supply codes (e.g., A9579) may be billed separately by the facility.
• Modifiers: Use 26 for Professional Component (Radiologist), TC for Technical Component (Facility).
• Reimbursement: Approx. $320–$330 (Medicare Global).

CPT® 70553 refers to a magnetic resonance imaging (MRI) study of the brain (including the brain stem) performed without contrast followed by with contrast in one session.

In practical terms, this code represents a two-part MRI exam: first, standard images of the brain are taken without any contrast dye, then an intravenous gadolinium-based contrast material is administered and additional images are obtained. The single CPT 70553 code bundles both the non-contrast and post-contrast sequences and the radiologist’s interpretation into one service.

Procedure Description

Magnetic Resonance Imaging (MRI) uses a powerful magnetic field and radiofrequency pulses to produce detailed images of internal body structures.

The Workflow for CPT 70553:

1. Baseline Imaging: The patient is positioned inside the scanner. Initial sequences (T1, T2, FLAIR) are obtained without contrast. These serve as a baseline for anatomy and pathologies like hemorrhage.
2. Contrast Injection: An IV line is used to inject a gadolinium-based contrast agent. This dye highlights blood vessels and breakdowns in the blood-brain barrier.
3. Enhanced Imaging: Post-contrast sequences are performed to detect enhancing lesions (e.g., distinguishing a tumor from edema).

Clinical Indications and Appropriate Uses

Doctors order CPT 70553 when they need the enhanced detail that contrast provides. Common indications include:

• Brain Tumors: Contrast highlights tumor tissue (which takes up gadolinium), differentiating it from surrounding edema.
• Multiple Sclerosis (MS): Active MS plaques enhance with contrast, distinguishing them from older, inactive lesions.
• Infection: Abscesses typically show “ring-enhancement” on post-contrast images.
• Post-Op Evaluation: Differentiating scar tissue from recurrent tumor (contrast helps separate the two).
• Stroke/TIA: Used when a CT is negative or to evaluate vascular malformations.

Code Comparison: 70551, 70552, 70553

It is critical to choose the correct code based on the technique used. Never bill 70551 and 70552 together; use 70553 instead.

flowchart TD
    A[MRI Brain Ordered] --> B{Contrast planned?}
    B -->|No contrast| C[Bill 70551 - MRI Without Contrast]
    B -->|With and Without| D{Both sequences completed?}
    B -->|Contrast only| E[Bill 70552 - MRI With Contrast Only]
    D -->|Yes| F[Bill 70553 - MRI W/ and W/O Contrast]
    D -->|No - contrast failed| G[Bill 70551 for completed non-contrast]
    F --> H{Billing setting?}
    H -->|Facility| I[Physician: 70553-26 / Facility: 70553-TC]
    H -->|Freestanding or Office| J[Bill 70553 Global]

Documentation and Coding Guidance

Proper coding requires specific elements in the radiology report:

• Technique: The report must state that images were obtained before and after contrast. It should list the contrast agent and dose (e.g., “15mL Gadavist”).
• Medical Necessity: Diagnosis codes must justify the use of contrast (e.g., “R56.9 Unspecified Seizure” or “C71.9 Malignant neoplasm”).
• Bundling Alert: Do not bill 70551/70552 if 70553 is performed. Medicare will deny unbundled claims.
• Multiple Areas: If an MRI Brain (70553) and MRI Orbit (70543) are done in the same session, they may be billed separately if medically necessary. Check NCCI edits.

Modifier Use for 70553

Correct modifiers ensure the right entity gets paid:

Billing for Contrast Supply

While CPT 70553 covers the imaging procedure, the facility (hospital or imaging center) may bill separately for the contrast material itself using HCPCS Level II codes.

• HCPCS Code: A9579 (Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified, per ml).
• Documentation: The volume injected (e.g., 10ml, 15ml) must be documented to support the units billed.
• Note: In some hospital outpatient settings (OPPS), contrast is “packaged” into the APC payment and not paid separately.

Reimbursement and RVU Benchmarks (2026)

Reimbursement varies by setting (Physician Fee Schedule vs. Hospital Outpatient).

• Medicare Global (Office/Freestanding): ~9.7 Total RVUs (Approx $320–$330).
  • Professional (26): ~$100.
  • Technical (TC): ~$220.
• Medicare Hospital Outpatient (OPPS): Technical fee is paid via APC (approx $290).
• Commercial Insurance: Allowables vary widely, typically $437–$689+ depending on the payer (BCBS, UHC, Aetna).

Clinical Scenarios

Scenario 1: Multiple Sclerosis Follow-up
A patient with known MS presents with new vision loss. The neurologist orders an MRI brain with and without contrast.
Coding: Bill 70553. The “without” portion checks brain volume/atrophy; the “with” portion highlights active demyelinating plaques. Do not bill 70551 separately.

Scenario 2: Brain Tumor (Hospital Setting)
A patient in the ER has a seizure. A mass is seen on CT. An MRI W/WO contrast is ordered.
Facility Billing: The hospital bills 70553 (Technical) on the UB-04 form.
Physician Billing: The radiologist bills 70553-26 on the CMS-1500 form for the interpretation.

Scenario 3: Failed Contrast
Technologist performs the non-contrast sequence. When attempting to start the IV for contrast, the patient’s vein blows and no other access is possible. The exam is stopped.
Coding: Bill 70551 (MRI Brain Without Contrast). Do not bill 70553-52, as 70551 accurately describes the completed service.

Frequently Asked Questions

Can I bill for 3D rendering (76376/76377) with 70553?

Only if the 3D rendering was specifically ordered, medically necessary, and required independent workstation processing. Routine 2D reformatting on the scanner console is included in the base MRI code and cannot be billed separately.

What if the patient is claustrophobic and the exam is aborted?

If the exam was started but discontinued before completion due to patient distress, use Modifier 53 (Discontinued Procedure) for the physician claim and Modifier 73/74 for the facility claim.