How To Use CPT Code 70554

CPT 70554 describes the procedure for functional magnetic resonance imaging (fMRI) of the brain, which involves assessing brain activity by tracking metabolic changes in response to neural activity. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 70554?

CPT 70554 can be used to describe the procedure for functional magnetic resonance imaging (fMRI) of the brain. This imaging technique allows healthcare providers to assess brain activity by tracking the metabolic changes that occur in response to neural activity. It provides valuable information about brain function and can be used to diagnose, manage, and treat various neurological conditions.

2. Official Description

The official description of CPT code 70554 is: ‘Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration.’

3. Procedure

1. The patient is positioned appropriately and may be sedated if necessary.
2. A radio antenna device called a surface coil is placed around the upper part of the head.
3. The patient is placed on a sliding table and inserted into a large tunnel-shaped magnetic scanner.
4. The patient is instructed to remain still while the images are taken.
5. During the examination, radio waves manipulate the magnetic position of atoms in the body, and a powerful radio antenna picks up the location of these atoms.
6. The computer converts the collected data into cross-sectional black and white images of the brain and brainstem.
7. In a functional MRI (fMRI), the patient is asked to perform tasks or undergo visual stimulation while inside the MRI unit.
8. A series of images are recorded to evaluate the effect of the task or stimulation on brain function.
9. The provider analyzes the images to assess brain activity and function.

4. Qualifying circumstances

CPT 70554 is used when functional MRI tests are administered by a technologist or other non-physician or non-psychologist healthcare professional. It does not require the direct administration of a physician or psychologist. This code is appropriate for cases where the provider selects and administers tests involving repetitive body part movement and/or visual stimulation to evaluate brain function.

5. When to use CPT code 70554

CPT code 70554 should be used when a functional MRI of the brain is performed, and the test does not require the direct administration of a physician or psychologist. It is important to ensure that the test involves the selection and administration of repetitive body part movement and/or visual stimulation to evaluate brain function. If the entire neurofunctional testing is administered by a physician or psychologist, CPT code 70555 should be used instead.

6. Documentation requirements

To support a claim for CPT 70554, the healthcare provider must document the following information:

• Indication for the functional MRI of the brain
• Details of the test selection and administration, including repetitive body part movement and/or visual stimulation
• Date and duration of the procedure
• Any relevant findings or observations during the test
• Signature of the healthcare professional performing or supervising the procedure

7. Billing guidelines

When billing for CPT 70554, ensure that the test is performed by a technologist or other non-physician or non-psychologist healthcare professional. It is important to note that CPT code 70554 should not be reported in conjunction with code 96020. If reporting only the physician’s interpretation for the radiology service, append modifier 26 to the radiology code. If reporting only the technical component, append modifier TC to the radiology code. However, payer policy may exempt hospitals from appending modifier TC. When reporting a global service where one provider renders both the professional and technical components, do not append a professional or technical modifier to the radiology code.

8. Historical information

CPT 70554 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition.

9. Examples

1. A technologist performing a functional MRI of the brain to assess language function in a patient with a suspected brain tumor.
2. A non-physician healthcare professional administering repetitive body part movement tests during a functional MRI to evaluate motor function in a patient with Parkinson’s disease.
3. A technologist conducting visual stimulation tests during a functional MRI to assess visual processing in a patient with a history of visual impairments.
4. A non-psychologist healthcare professional administering cognitive tasks during a functional MRI to evaluate memory function in a patient with Alzheimer’s disease.
5. A technologist performing a functional MRI to assess brain activity during a specific task in a research study on decision-making processes.
6. A non-physician healthcare professional conducting repetitive body part movement tests during a functional MRI to evaluate motor function in a patient with multiple sclerosis.
7. A technologist administering visual stimulation tests during a functional MRI to assess visual processing in a patient with a suspected visual processing disorder.
8. A non-psychologist healthcare professional conducting cognitive tasks during a functional MRI to evaluate executive function in a patient with attention deficit hyperactivity disorder (ADHD).
9. A technologist performing a functional MRI to assess brain activity during a specific task in a patient participating in a clinical trial for a new treatment for depression.
10. A non-physician healthcare professional administering repetitive body part movement tests during a functional MRI to evaluate motor function in a patient recovering from a stroke.