CPT 70553: Brain MRI With & Without Contrast

Magnetic Resonance Imaging (MRI) is a cornerstone of modern neurological diagnostics. When a comprehensive view of the brain is needed especially in cases involving tumors, strokes, or multiple sclerosis physicians often order a study that includes both non-contrast and contrast-enhanced imaging. This is captured through CPT code 70553, which encompasses both imaging phases performed in a single session.

Accurate use of this CPT code ensures providers are reimbursed appropriately, and it reflects the true complexity of the diagnostic work performed.

What CPT 70553 Covers

CPT 70553 is defined as:

Magnetic resonance imaging, brain (including brain stem); without contrast material(s), followed by with contrast material(s) and further sequences.

This code is applicable when both non-contrast and contrast images are acquired during the same appointment. The initial scan captures baseline brain anatomy, while the contrast-enhanced sequence helps detect or clarify pathologies such as vascular lesions, neoplasms, or inflammation.

When Is CPT 70553 Appropriate?

CPT 70553 should be reported when a complete evaluation is necessary to address complex or unresolved neurological symptoms. The dual-phase approach improves diagnostic accuracy and is often recommended in the following clinical scenarios:

• Investigation of brain tumors or masses

• Evaluation of multiple sclerosis progression

• Diagnosis of stroke or transient ischemic attacks

• Suspected encephalitis or brain abscess

• Follow-up on post-operative changes

• Assessment of unexplained cognitive decline or seizures

It is especially valuable when:

• Lesions may enhance with contrast while appearing normal on non-contrast images

• Providers are differentiating between tumor recurrence and post-treatment changes

• Subtle abnormalities need clarification in critical brain areas

What Documentation Is Required?

Thorough and accurate documentation is key to justifying the use of CPT 70553. Clinical records should include:

• A referral or order stating “MRI brain with and without contrast”

• Clinical rationale for both imaging phases

• Details of the contrast agent administered

• Radiologist’s comprehensive report interpreting both sequences

The lack of any of these elements may lead to payer rejections or audits.

Billing and Modifier Application

Only report CPT 70553 once per session. Avoid combining CPT codes 70551 (without contrast) and 70552 (with contrast) this is a common billing mistake and often results in denials.

Use the appropriate modifiers when billing separately for components:

• Modifier 26 – Professional component (radiologist interpretation)

• Modifier TC – Technical component (equipment, staff, and facility)

In situations where a repeat MRI is performed on the same day due to new or worsening symptoms, use Modifier 76 to indicate a repeat service by the same provider. This modifier plays a crucial role in preventing denials for what might appear as a duplicate charge.

Proper use of Modifier 76 and medical billing and insurance credentialing services ensures clean claim submission, accurate reporting of repeat procedures, and compliance with payer-specific rules. Without this expertise, providers risk delayed reimbursements or rejected claims even for medically necessary imaging.

Relevant ICD-10 Codes

Choose a diagnosis that supports the need for a dual-phase MRI. Below are some commonly paired ICD-10 codes:

Accuracy in diagnosis selection helps avoid claim denials and supports the documentation for medical necessity.

Authorization and Payer Expectations

Because CPT 70553 includes the use of contrast, many insurers especially Medicare and commercial payers require prior authorization. Payers may also demand chart documentation for:

• Medical necessity of contrast

• Credentialing verification of the provider

• Appropriate use of modifiers and diagnosis codes

If prior approval is missed or the documentation is vague, the claim is likely to be denied or subject to further review.

Common Coding Errors to Avoid

• Submitting 70551 and 70552 together instead of using 70553

• Failing to include Modifier 76 for same-day repeat imaging

• Lack of documentation regarding contrast usage

• Using nonspecific or unrelated ICD-10 codes

• Billing under uncredentialed providers, delaying payment

Quick Checklist for Billing CPT 70553

Confirm the order includes both non-contrast and contrast
Justify contrast use in the clinical notes
Verify payer authorization (especially in outpatient settings)
Use Modifier 26 or TC if billing components separately
Use Modifier 76 if the same procedure is repeated due to medical necessity
Ensure your providers are properly credentialed with the payer

Conclusion

CPT 70553 reflects a complex but essential diagnostic service that provides a deeper look into a patient’s brain health. It’s often a turning point in care helping providers detect critical conditions early and plan more effective treatment strategies.

By understanding how to accurately apply Modifier 76 and medical billing and insurance credentialing services, healthcare practices can protect revenue, maintain compliance, and ensure timely reimbursement. In a landscape where administrative precision is as vital as clinical excellence, mastering the nuances of CPT 70553 benefits both providers and patients alike.