70553 Brain MRI Medicare reimbursement rates in Virginia

Brain MRI under this code covers the brain and brain stem using diagnostic noncontrast sequences followed by contrast-enhanced sequences during one examination. Sequences may include T1, T2, FLAIR, and diffusion imaging before intravenous gadolinium, with additional imaging afterward. Radiologists or neuroradiologists interpret examinations performed in hospital radiology departments, outpatient imaging centers, or physician offices. Typical reasons to obtain both phases include assessment of a brain tumor or metastases, active demyelination, intracranial infection, or a pituitary lesion.

Report one unit for the combined examination, rather than reporting 70551 and 70552 for its separate phases. Documentation should establish that diagnostic images were obtained before and after contrast administration; the administration record supports the agent and amount if the supply is separately reported. The interpreting physician reports the professional component with modifier 26, while the provider furnishing equipment and staff reports the technical component with modifier TC. An entity furnishing both components reports the global service without either modifier. Medicare's diagnostic imaging multiple-procedure reduction affects professional and technical components when this examination is performed with other eligible imaging services under the applicable same-session criteria.