MRI CPT Codes: Complete Billing & Coding Guide

MRI CPT Codes are named after the area of the body that is imaged and distinguish between scans that use contrast. There are several details that a coder needs to review to arrive at the correct code. These include the body region, the type of contrast used, if any, whether the study was done without contrast and then with contrast, and whether the radiologist documentation supports the code. This is only a summary of the requirements and there are several exceptions. Authorization, component billing, and incorrect contrast selection are a few of the exceptions that may result in a claim being denied.

This reference is for medical coders and billers, office and hospital based radiology staff and management in the United States. It also is for the public interested in learning the details of MRI billing. The reference describes the details of the billing process and gives examples of the exceptions.

Quick Reference: Common MRI CPT Codes by Body Area

Cardiac MR imaging contains codes 75557, 75559, 75561, 75563 and 75565. Selection of the appropriate code for Cardiac MR imaging requires knowledge of the elements of the study and should be determined by referencing the current CPT code publication. It is unlikely that the elements of the Cardiac MR imaging study would match the Cardiac CT imaging study element (with-contrast/without-contrast) to the extent that determination of the appropriate CPT code for Cardiac MR imaging study could be made. The same is true for functional MR imaging, MR angiography and other complex MR imaging studies.

A Reliable MRI Coding Process Requires Comparison and Contrast.

An adequate MRI coding process, where a final report drives code assignment, begins with a description of the anatomy reported on. Next, the MRI coding process determines whether the study was a joint study, or a non-joint extremity study. Next, the MRI coding process identifies the sequence of contrast material. Ultimately, the coding process compares the findings to the payer and authorization rules.

Let’s consider a case where a patient has a right knee injury from a sporting event. A right knee MRI without contrast is ordered. The final report describes the MRI as a study of the right knee without contrast and explains it as a joint study of the lower extremity. Therefore, 73721 is the correct code. If the study was of the right knee with contrast, then 73722 would be the correct code. There are other times when a joint study of the lower extremity is ordered and the study is done both with and without contrast. If this were the case, then 73723 would be the appropriate code.

Brain, Head, and Neck MRI Codes

Brain MRIs are some of the most requested MRIs, and as a result, brain MRA coding is well known. Brain MRIs without contrast are reported with code 70551, with contrast codes 70552, and without contrast first and then with contrast and additional sequences reported with code 70553. Similar tripartite schemes can be found in several other MRIs; however, it must be kept in mind that not all schemes in all families of MRIs are of this nature.

Orbit, face, and neck MRIs are reported with codes 70540, 70542, and 70543, respectively. These codes are frequently confused with MRA (Magnetic Resonance Angiography) codes, which are used for vascular imaging. The ACR has noted that codes 70544-70546 are used for MRA of the head, and codes 70547-70549 are used for MRA of the neck. If there is a request for vascular imaging, it would be erroneous to assign an MRI code, because the imaging modality is magnetic resonance.

Spine MRI Codes: Cervical, Thoracic, and Lumbar

Coding for Spine MRI studies is based on the region of the spine and contrast. There are differences in the coding based upon the location of the MRI, whether it be cervical, thoracic, or lumbar. The 72141 series codes are used for cervical MRI studies. The 72146 series codes are used for thoracic MRI studies. The 72148 series codes are used for lumbar MRI studies. The same rule for region also applies to contrast.

A mistake that is commonly made by coders is swapping code descriptions for regions. Examples of swapping codes include using 72141 for thoracic MRI code and 72146 for cervical MRI code. An MRI study can only be ordered with or without contrast. A code described as with contrast and without contrast (i.e. 72141 and 72156) cannot be reported if only one of the contrast phases is performed. The coder should also check if the final report requests a specific region and contrast, and not report if the order and the final report do not match.

Joint and Extremity MRI Codes

Musculoskeletal MRI procedures vary depending on whether the body part being studied is a joint or a body part other than a joint (extremity) of the upper or lower limb. 73221-73223 are the codes for MRI studies of joints of the upper extremity. 73218-73220 are the codes for MRI studies of the body parts other than joints of the upper extremity. 73721-73723 are the codes for lower extremity joint studies. Codes for lower extremity studies of body parts other than joints are 73718-73720.

Knowing the codes for joint studies becomes important when a code is requested for a study of a knee or shoulder, for example. A knee being a lower extremity joint means that the contrast status of the study would determine if the correct code is 73721, 73722, or 73723. A shoulder being an upper extremity joint means that the correct code would be 73221-73223. It is important to note that when a study of an extremity includes adjacent, or surrounding, soft tissues, the code for a body part other than a joint should not be assigned.

Abdomen and Pelvis MRI Codes

Abdomen MRI codes 74181 and 74182 refer to the study with and without contrast, respectively. Code 74183 indicates both contrast and a study of the pelvis. Pelvic MRIs commonly use 72195, 72196, and 72197. All of these codes represent contrast MRIs. These families of codes are similar, and it can be difficult to determine which codes to assign to a given study when an order mentions symptoms in the abdomen and pelvis. In these situations, it is best practice to assign codes based on the study and documentation rather than based on the symptoms described in the diagnosis.

When assigning codes for MR Angiography (MRA), it is also important to remember that an MRA study of the abdomen is coded separately from an MRI of the abdomen. Many payer policies provide guidance on assigning MRA codes in the absence of an MRA family code.

Breast MRI Codes: Watch for Older References

Breast MRI coding generally involves using 77046 for a (noncontrast) unilateral breast MRI, 77047 for a bilateral breast MRI (again, noncontrast), 77048 for a (noncontrast) unilateral breast MRI with a contrast agent MRI of the same side, and 77049 for a bilateral breast MRI with a contrast agent. Older articles, especially those found in the Internet, may describe or mention the retired breast MRI codes, and for this reason among others, these articles should not be relied upon to define or interpret current CPT codes.

When breast imaging is performed, the laterality of the examination should be indicated in the code. Also, if both breasts were included in the examination, this should also be indicated. Because separate payments may be made for each side, the indication for the examination (i.e., screening or diagnostic) should also be indicated, as different payers may make payment for the same examination based upon this indication.

Cardiac MRI: Do Not Force It Into the Standard Contrast Pattern

Cardiac MRIs are specialized studies to evaluate the anatomy and function of the heart, and can identify other abnormalities, like myocardial ischemia. Code selection for cardiac MRI studies can be challenging, as various elements of the study can be imaged and/or evaluated (e.g., cardiac morphology, function, flow, perfusion, and related sequences). Common codes for cardiac MRIs include 75557, 75559, 75561, 75563, and 75565. When elements of a cardiac study are represented by more than one element (e.g., anatomy and function), code the element most complementary to the cardiac study. For example, if contrast is administered to evaluate myocardial perfusion, and cardiac studies are performed to evaluate function (e.g., evaluate wall motion), cardiac function studies (e.g., wall motion) should be coded in addition to myocardial perfusion studies (e.g., use code 75561).

Contrast Coding: Three Similar Phrases With Different Meaning

Services described as ‘without contrast’ or ‘with contrast’ represent distinct offerings. When a service is described as ‘without contrast,’ the service was performed without the administration of contrast. When a service is described as ‘with contrast,’ it represents the service with the contrast code descriptor. ‘Without and with contrast’ is used to describe non-contrast and contrast enhanced images, respectively.

A common mistake is to assign the ‘without and with’ code when a service with contrast is performed and documented. This is not permitted. The service report must support both the non-contrast and contrast enhanced service in order to assign the ‘without and with’ code. Likewise, a service without contrast is permitted when a planned contrast service is changed and the non-contrast service is performed and documented.

The statements and guidance in this policy are based on currently available evidence and it is recognized that given the rapid developments in medicine and reimbursement methodologies, the policy may require updates.

Common MRI Modifiers

Modifier 26: Professional Component

Modifier 26 is assigned to the professional component of a service performed by a radiologist when that service is distinct from the imaging service. An imaging center, for example, may perform an MRI, but a radiologist may be employed by, or under contract with, the imaging center to review the images and other MRI studies, and to prepare a final report. In that case, the radiologist is allowed to bill for the professional component with Modifier 26, if the payer and the terms of the contract allow for it. It is essential that Modifier 26 be properly used in radiology billing services, because that modifier differentiates the radiologist’s professional service from the other services (technical and support services) required to perform the MRI.

Modifier TC: Technical Component

Modifier TC represents the technical component for that component is reportable separately. TC generally reflects the cost of equipment, the work of a technical services provider (e.g. radiologic technologist), and other technical services. Whether Modifier TC is permissible is based upon the Payers’ guidelines, Payers’ rules, place of service, and ownership.

Modifier 59 and Distinct Services

Modifier 59 indicates that the service was distinct, in that it was not part of the same service as the other MRI service. It is unnecessary to append Modifier 59 to MRI codes, and its use should be limited to unusual cases that warrant reporting a service as separate from the other services (e.g. may be reported if MRI services are provided at different times on the same day). Use of Modifier 59 should be based on the documentation. CMS is currently concerned with the reporting of excessive magnetic resonance imaging (MRI) services, and may review the services for medical necessity and whether less extensive MRI services were appropriately performed and billed at the same location as a more extensive MRI service to which it is bundled. Therefore, use of Modifier 59 to overcome edit constraints should be done judiciously.

Laterality and Bilateral Studies

For procedures coded by CPT description only, laterality and bilateral reporting can influence the construction of the imaging-related medical record and, in turn, affect coding and editing decisions. This is the case even when the descriptors of the parent CPT code are not side-specific. Payers differ in the requirements, if any, that they set for reporting right versus left (RT/LT), and for the use of modifier 50. It is important to ascertain the reporting preference of the payer, including whether they require the use of separate claim lines. The paying entity may require that the ordering and interpreting providers document and report the side (s) being assessed and/or imaged.

Professional, Technical, and Global MRI Billing

Some imaging services, such as MRIs, include a technical component and a professional interpretation component. If a single entity provides both of these components in an at-county location, that entity may be able to bill the professional and technical components of the service together (i.e. global billing) depending on the requirements of the payer and contract. If different entities provide the components, the professional and technical components are billed separately.

In a hospital outpatient setting, the hospital generally bills the technical component of the service. The radiologist interpreting the image may be able to bill the professional component of the service. It is important to note that differing payment, modifier and claim formats may apply to services furnished by physicians in different practice settings. For example, services provided in a hospital outpatient department may differ from services provided in a physician office or independent diagnostic testing facility.

Prior Authorization: Match More Than the Authorization Number

Many commercial plans and management programs require prior authorization for different levels of imaging. The denials for the most preventable MRIs occur when a retrospective authorization is processed after the claim has been adjudicated. The adjudication of the claim, however, is based on the information contained in the CPT code, anatomy, laterality when appropriate, the imaging facility, the ordering and/or interpreting practitioner, and the time frame during which the imaging was performed. If any of the aforementioned variables are not at equilibrium, a denial may occur.

If the interpreting radiologist determines that an imaging protocol is unsafe, that safety concern may dictate a change of the protocol. If that occurs, it is imperative that the authorization be changed to reflect the new imaging protocol in order to avoid a denial. A claim may be appropriate, but if the imaging code that is authorized for payment does not reflect the code for the service that was performed, a denial may occur.

Medical Necessity and ICD-10-CM Documentation

A full understanding of a requested MRI requires both a corresponding CPT code and ICD-10-CM code. These codes are submitted on a radiology claim and explain to the payer what service was performed and the reason the service was required. In order for a claim to be processed and payment to be received, the reason for the service must be fully documented and support MRI as medically necessary.

While understanding payer policies is important, it is equally important to not focus on payment policies and unrelated information when determining a code. Rather, the coder should assess the detail of the case documentation and assign a code to best represent the condition described. The documenting provider is responsible for the information and coding practices of the case. If the documentation does not support the reason for service, it is not the coder’s responsibility to justify the service to the payer.

MRI Safety Codes 76014-76019

A series of codes has been developed for use with patients that require additional MRI safety evaluation due to the presence of foreign bodies or implanted medical devices. These codes will be implemented in 2025, and include codes 76014-76016 for MRI safety evaluation services and 76017-76019 for related MRI safety services. Routine MRI safety evaluation services will remain non-billable.

Routine MRI safety evaluation services will consist of components of larger services and will be described in the CPT Editorial (or Clinical) policies. Code 76014 describes the initial assessment of a foreign body or implanted medical device by a licensed clinician and Code 76015 describes additional assessment by a licensed clinician. Code 76017 describes the modification of an MRI exam due to the presence of implanted medical device electronics, and Code 76018 describes additional MRI safety services related to positioning or immobilization of the patient. Because the policies are detailed, they should be consulted before services are performed and billed.

Common MRI Coding Mistakes That Lead to Denials

1. Wrong contrast status

The description provides a without and with comparison, but the report does not. Alternatively, the report provides a non-comparative description, and the description does not.

2. Wrong anatomy

A code has been selected from the wrong family for either cervical, thoracic, lumbar, joint, or non-joint.

3. MRI and MRA confusion

An MRI of the vessels is coded similarly to an X-ray angiography.  An X-ray angiography is coded as an exam of the vasculature. An MRI of the brain with and without contrast is coded as an MRI of the brain.

4. Authorization mismatch

The code, site, date, or anatomy of the service performed does not match the approved code, site, date, or anatomy.

5. Unsupported modifier

Modifiers can be appended to bypass an edit when editing documentation does not show evidence of a distinct service.

6. Component billing error

The claim reports a global service despite the fact that the billing entity provided only the technical or professional component of the service.

7. Outdated code reference

The team is using outdated sources like blog posts, cheat sheets, and old code instead of the current version of the CPT codes.

8. Weak medical necessity support

The diagnosis and clinical documentation do not meet the MRI criteria for medical necessity as defined by the payer.

A Practical Pre-Bill MRI Checklist

• Identify the correct body part, and confirm if the study is joint or non-joint.
• Confirm the contrast status from the final report.
• Ensure the CPT code on the request is the same as the CPT code on the authorization.
• Confirm laterality and bilateral instructions.
• Review modifiers as applicable.
• Confirm the reason for the service is supported by the medical records and is medically necessary.
• Confirm services are not bundled according to payer requirements and NCCI edits.
• Confirm the services are provided in the correct place of service and determine if the services provided are professional, technical, or global.
• The most recent CPT codes should be used. EOB codes should not be used to determine medical necessity.

Real-World Billing Scenarios

Scenario 1: Knee MRI Without Contrast

A patient visits an orthopedic practice with a history of right knee pain that worsens with injury. The practice orders an MRI to further evaluate the injury. The imaging center completes the MRI of the right knee without contrast and sends the study with the initial order. The final report from radiology is documented and filed. The imaging center assigns CPT code 73721 for the service. Prior to submitting the claim, the billing team reviews laterality, checks if the payer requires prior auth for the service, and evaluates medical necessity for the diagnosis. The team is well aware that to bill a service, it must confirm several elements. While performing these duties, the team verifies the order was approved, the service was performed according to the order, and the order was performed by the appropriate entity. These practices are essential for the orthopedic medical billing services and decrease the billing cycle time.

Scenario 2: Brain MRI Before and After Contrast

A neurologist requests a brain MRI. The radiologist reports the MRI was performed without contrast, and then with contrast. CPT code 70553, is assigned for describing brain MRI without and with contrast. If authorization was granted for another brain MRI, and the description does not align with the brain MRI performed, the authorization must be revised to align with the brain MRI performed prior to the release of the claim.

Scenario 3: Bundling Concern with Lumbar MRIs

The same lumbar MRIs are performed on the same day and at the same location. More than one lumbar MRI code can be submitted on the same claim. According to CMS, extensive MRI services may bundle less extensive MRI services performed at the same location. It is important to review the edit and final report to determine if the documented MRI service supports both MRI codes. Coders are not to interpret edit logic and attempt to keep both MRI codes on the claim.

Scenario 4: Implant Requires Additional MR Safety Work

A patient has an implanted device with MR conditions, for which additional safety practices beyond standard risk assessment are required. The team completes the work and reviews the currently available descriptors in the ICD-10-CM 2019 update (76014-76019) to make a determination about the reportability of a safety service. In the absence of routine screening, these codes would not be assigned.

Frequently Asked Questions About MRI CPT Codes

What CPT code is used for an MRI?

There is no single MRI CPT code. The code depends on the anatomy, type of study, and often contrast status. Brain MRI, spine MRI, joint MRI, abdomen MRI, breast MRI, MRA, and cardiac MRI use different code families.

What is the CPT code for a brain MRI without contrast?

CPT 70551 is commonly used for MRI of the brain without contrast. Verify the current CPT descriptor and payer requirements before billing.

What is CPT 70553?

CPT 70553 represents brain MRI performed without contrast followed by contrast material and additional sequences.

What is the CPT code for a lumbar spine MRI without contrast?

CPT 72148 is the common code for lumbar spine MRI without contrast.

What is the CPT code for a knee MRI without contrast?

A knee is a lower-extremity joint. CPT 73721 is the common code for lower-extremity joint MRI without contrast.

Do MRI procedures require prior authorization?

Many commercial insurance plans require prior authorization for non-emergency advanced imaging, but requirements vary by payer, plan, diagnosis, and setting. Verify the patient’s specific benefits and authorization rules.

Can 70551 and 70553 be billed together for the same brain MRI?

Do not assume both are separately reportable. A more extensive MRI service can include a less extensive service. Review the actual study, current CPT instructions, NCCI edits, and payer policy before billing multiple MRI codes for the same site.

Are contrast agents included in the MRI CPT code?

The imaging CPT code describes the MRI service, but contrast material billing can involve separate HCPCS reporting depending on the setting and payer. Verify the agent, units, documentation, and payer rules.

Final Analysis

The best way to utilize the MRI CPT codes is to view the code list as a starting point, rather than an end point, to the billing process. Only after determining the final report and contrast status of the case should the code list be reviewed. Authorization, diagnosis, support and modifiers should also be reviewed, as should component parts of the overall service and payer edits. Often, there are numerous reasons for an code rejection, and review of the code list alone will not identify all of the reasons for rejection.

When in doubt, it is best practice to review the AMA CPT guidance rather than speculate on MRI code assignment. Radiology practices and billing entities should be focused on assigning the most accurate code to reflect the service rendered rather than focusing on the code that results in the greatest reimbursement.

Authoritative References 

• American Medical Association (AMA), current CPT code set and CPT guidance.
• Centers for Medicare & Medicaid Services (CMS), Medicare coverage, NCCI edits, and billing guidance.
• American College of Radiology (ACR), radiology coding resources and current radiology coding updates.
• Applicable Medicare Administrative Contractor and commercial payer medical policies.