CPT code 70555: Functional brain MRI, physician or psychologist2026 Medicare rate & RVUs in Missouri
Functional brain MRI maps task-related brain activity; report this code when a physician or psychologist participates in the examination and interpretation.
CMS doesn’t publish an office rate for 70555 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 70555 covers
This service is functional MRI of the brain used to map activity associated with tasks such as language or movement. A physician or psychologist participates in the examination; the professional service includes interpretation and a report. Functional mapping is commonly used when clinicians need to identify important functional areas in relation to a planned brain procedure, including evaluations of brain lesions or seizure disorders. It is performed in hospital and imaging-center settings.
Medicare assigns status C, carrier priced: CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim. Report modifier 26 for the professional interpretation, modifier TC for the technical service, or neither modifier for the global service. When performed bilaterally, each side is paid separately. Code 70554 is the related technologist-performed functional brain MRI service; choose between these codes according to whether a physician or psychologist participates in the examination.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 70555 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | Unavailable |
| Metropolitan St. Louis, MO | Unavailable | Unavailable |
| Rest of Missouri | Unavailable | Unavailable |
How the 70555 rate is calculated
Each of 70555’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 70555
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 70555
The CMS indicators that decide how 70555 is paid alongside other services.
CMS payment indicators · 70555
Functional brain MRI, physician or psychologist
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 3 | Each side paid at 100% (no 150% cap). |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
70555 without 26 · national facility
$0.00
Functional brain MRI, physician or psychologist
70555-26 · Professional component
$114.23
Pays only the interpretation and report.
70555 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 70554Functional brain MRITechnologist acquisition
- Use 70555 when a physician or psychologist participates in the functional MRI examination. Use 70554 for the technologist-performed service.
- 70557Brain MRIWithout contrast
- 70557 reports structural brain MRI without contrast; 70555 reports functional brain mapping with physician or psychologist participation.
- 70559Functional brain MRIWithout and with contrast
- 70559 reports structural brain MRI without and with contrast. It is distinct from functional brain mapping reported with 70555.
70555 billing questions
How does this differ from 70554?
Use 70555 when a physician or psychologist participates in the functional MRI examination. Code 70554 describes the technologist-performed functional brain MRI service.
When should modifier 26 or TC be used?
Use modifier 26 for the professional interpretation and report, and modifier TC for the technical service. Report the global service without either modifier.
How does Medicare price this code?
It has carrier-priced status C. CMS publishes no national payment; the Medicare Administrative Contractor sets payment for each claim.
How are bilateral services treated?
When the service is performed bilaterally, each side is paid separately.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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