CPT Code 70553 Explained: Brain MRI With & Without Contrast Billing Guide
CPT code 70553 represents one of the most frequently ordered neuroimaging studies in medical practice. Neurologists, neurosurgeons, primary care physicians, emergency departments, and numerous specialists order brain MRI studies daily to evaluate headaches, neurological deficits, seizures, tumors, infections, and countless other conditions. The test provides invaluable diagnostic information that guides treatment decisions and saves lives.
Despite being common, this code gets billed incorrectly more often than radiology departments realize, creating audit exposure and revenue problems.
A radiology group performs brain MRI studies throughout each day. They bill code 70553 for every brain MRI that includes contrast administration regardless of whether non-contrast images were also obtained. After 18 months of this billing pattern, Medicare audits 25 randomly selected brain MRI claims. The auditor finds that 14 of the 25 claims were coded incorrectly.
Some studies included both non-contrast and contrast sequences which requires code 70553, but others included only post-contrast images which requires code 70552 instead. Several studies were performed without any contrast which requires code 70551. The extrapolated overpayment across the audit period: $67,000. The group must refund it immediately.
Another radiology practice bills code 70553 correctly but fails to bill separately for the contrast material administered. They lose thousands annually in legitimate revenue by not billing the gadolinium with appropriate HCPCS codes. The practice performs 200 contrast MRI studies monthly but captures revenue only for the imaging, not the expensive contrast agents used.
A hospital radiology department bills 70553 for brain MRI studies but their radiologist reports do not document that both non-contrast and post-contrast sequences were performed. During an audit, claims get denied because documentation does not support that the complete study described by code 70553 was actually performed. The department loses revenue and faces questions about coding accuracy.
These scenarios happen constantly across radiology practices nationwide. Understanding exactly what code 70553 covers, how it differs from related brain MRI codes, what sequences must be performed, what documentation requirements exist, how to bill contrast materials separately, and how to avoid common errors prevents denied claims and compliance problems while capturing appropriate revenue.
What CPT Code 70553 Represents
CPT code 70553 describes magnetic resonance imaging of the brain including brainstem performed without contrast material followed by contrast material administration and further imaging sequences. The full CPT descriptor states: “Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences.” This code represents a complete brain MRI protocol that includes both non-contrast imaging and contrast-enhanced imaging performed during the same imaging session.
Magnetic resonance imaging uses powerful magnets and radiofrequency pulses to create detailed images of brain structures, white matter, gray matter, blood vessels, and pathology. Unlike CT scans which use radiation, MRI uses magnetic fields making it safer for repeated imaging and better for visualizing many brain pathologies. Brain MRI provides superior soft tissue contrast compared to CT, allowing detection of tumors, inflammation, infection, ischemia, demyelination, and structural abnormalities that CT might miss.
The Two Components Required for Code 70553
Code 70553 specifically requires two distinct imaging phases performed during the same examination. Understanding what each phase involves clarifies when code 70553 is appropriate versus when other brain MRI codes should be used.
Phase 1: Non-contrast imaging involves acquiring brain MRI sequences before any contrast material is administered. The patient is positioned in the MRI scanner. Multiple imaging sequences are performed using different MRI parameters to visualize brain structures from various perspectives. Common non-contrast sequences include T1-weighted images which show anatomic detail, T2-weighted images which highlight fluid and pathology, FLAIR
(fluid-attenuated inversion recovery) images which suppress cerebrospinal fluid signal to better visualize periventricular and cortical lesions, diffusion-weighted imaging which detects acute ischemia and other diffusion changes, and gradient echo or susceptibility-weighted imaging which detects hemorrhage and calcium.
These non-contrast sequences are acquired across multiple planes including axial (horizontal slices), sagittal (side-to-side slices), and coronal (front-to-back slices). The non-contrast phase typically generates hundreds of individual images across all sequences and planes. This phase provides baseline images showing brain anatomy and any pathology visible without contrast enhancement.
Phase 2: Contrast material administration and post-contrast imaging involves injecting gadolinium-based contrast material intravenously followed by acquisition of additional MRI sequences after the contrast has distributed through the bloodstream and brain tissues.
Gadolinium contrast shortens T1 relaxation time causing areas where contrast accumulates to appear bright on T1-weighted images. This enhancement helps identify tumors, infections, inflammation, breakdown of the blood-brain barrier, and vascular abnormalities.
After contrast injection, post-contrast T1-weighted sequences are acquired in multiple planes. The imaging protocol may include standard post-contrast T1 images, fat-suppressed T1 images to better visualize enhancement in certain regions, and sometimes specialized sequences to assess contrast kinetics. The radiologist compares non-contrast and post-contrast images to identify areas of abnormal enhancement indicating pathology.
Both phases must be performed and documented to bill code 70553. If only non-contrast imaging is performed without any contrast administration, a different code applies. If only
post-contrast imaging is performed without dedicated non-contrast sequences, a different code applies. Code 70553 specifically describes the complete protocol with both phases.
What “Without Contrast Material, Followed by Contrast Material(s) and Further Sequences” Means
The descriptor language is very specific. It states “without contrast material” indicating non-contrast imaging must be performed first. It then states “followed by contrast material(s)” indicating contrast is subsequently administered. It concludes with “and further sequences” indicating additional imaging is performed after contrast administration.
This language makes clear that code 70553 requires a specific sequence of events: non-contrast imaging first, then contrast administration, then post-contrast imaging. This protocol allows comparison of pre-contrast and post-contrast images to identify enhancement patterns. The comparison is diagnostically valuable because it distinguishes areas that appear bright on T1 due to blood products, protein, or melanin from areas that appear bright due to actual contrast enhancement.
Some radiologists skip the non-contrast phase when clinical questions specifically require only assessment of enhancement. For example, a patient with known brain tumor undergoing routine surveillance might receive only post-contrast imaging if the clinical question is solely about tumor enhancement without need for full anatomic detail. When only post-contrast sequences are performed, code 70553 is incorrect. A different code applies for studies performed with contrast but without dedicated non-contrast sequences.
What “Brain (Including Brain Stem)” Covers
The code specifies “brain (including brain stem)” which defines the anatomic area covered. This includes the cerebral hemispheres containing frontal, parietal, temporal, and occipital lobes, deep gray matter structures including basal ganglia and thalami, white matter tracts throughout the hemispheres, the ventricular system containing cerebrospinal fluid, the cerebellum in the posterior fossa, and the brainstem including midbrain, pons, and medulla extending down to the foramen magnum.
Anatomic areas not included in brain MRI codes include the cervical spine which has separate MRI codes, the orbits and optic nerves which have separate codes when imaged in detail, the pituitary gland and sella which have separate codes for dedicated pituitary MRI, the internal auditory canals and cerebellopontine angles which have separate codes for dedicated IAC protocol, and facial bones and paranasal sinuses which have separate codes.
Standard brain MRI includes portions of the orbits, skull base, and upper cervical spine as they appear on brain sequences, but dedicated imaging of these structures requires separate codes.
If brain MRI is performed with code 70553 and the patient also needs dedicated cervical spine MRI, both studies are billed separately with appropriate codes.
The Brain MRI Code Family: 70551, 70552, and 70553
CPT code 70553 is part of a three-code family describing brain MRI studies that differ based on contrast use. Understanding all three codes and when each applies prevents the single most common billing error with brain MRI – using the wrong code based on the contrast protocol performed.
CPT 70551 – Brain MRI Without Contrast
Code 70551 describes magnetic resonance imaging of brain without contrast material. The full descriptor states: “Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material.” This code covers brain MRI performed entirely without any contrast administration.
Use code 70551 when the complete brain MRI examination is performed using only
non-contrast sequences without any gadolinium injection. The study includes all necessary sequences to answer the clinical question – T1-weighted, T2-weighted, FLAIR,
diffusion-weighted, and any other sequences performed – but no contrast material is administered and no post-contrast sequences are acquired.
Clinical situations appropriate for non-contrast brain MRI include acute stroke evaluation where diffusion-weighted imaging detects acute ischemia without need for contrast, headache evaluation in low-risk patients where structural abnormalities are being excluded, multiple sclerosis surveillance in some protocols where non-contrast sequences detect new lesions, seizure evaluation looking for structural causes, trauma evaluation assessing for hemorrhage and structural injury, and screening studies in patients with contraindications to gadolinium contrast such as severe renal insufficiency or prior allergic reactions.
CPT 70552 – Brain MRI With Contrast
Code 70552 describes magnetic resonance imaging of brain with contrast material. The full descriptor states: “Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s).” This code covers brain MRI performed with contrast administration but without dedicated non-contrast sequences.
Use code 70552 when gadolinium contrast is administered and post-contrast sequences are acquired, but the protocol does not include dedicated non-contrast sequences before contrast injection. Some clinical situations justify obtaining only post-contrast images when non-contrast images are not needed for the specific diagnostic question.
Clinical situations where contrast-only imaging might be appropriate include follow-up imaging of known brain tumors where prior baseline non-contrast images exist and current study needs only to assess tumor enhancement, specific protocols for metastatic disease screening where rapid post-contrast imaging detects enhancing lesions, some infection evaluations where enhancement pattern is the primary diagnostic feature, and certain vascular imaging protocols where post-contrast imaging is combined with MR angiography.
However, code 70552 is less commonly used than codes 70551 and 70553 because most brain MRI protocols include non-contrast sequences for anatomic detail even when contrast will be administered. Radiologists want baseline non-contrast images for comparison to post-contrast images. When both are performed, code 70553 applies rather than 70552.
CPT 70553 – Brain MRI Without and With Contrast
Code 70553 describes the complete brain MRI protocol with both non-contrast and contrast-enhanced imaging as detailed in the opening section. This is the most comprehensive brain MRI study and the most commonly performed protocol for most diagnostic indications.
Use code 70553 when the brain MRI protocol includes both dedicated non-contrast sequences performed before contrast administration AND post-contrast sequences performed after gadolinium injection. Both phases must be performed during the same imaging session.
Clinical situations appropriate for complete non-contrast and contrast imaging include tumor evaluation where non-contrast sequences show mass effect and edema while contrast sequences show enhancement pattern, infection evaluation like abscess or meningitis where contrast shows inflamed tissues, inflammatory conditions like multiple sclerosis where contrast identifies active lesions, metastatic disease evaluation where complete assessment requires both anatomic detail and enhancement, vascular malformations where contrast helps characterize lesion vascularity, and comprehensive evaluation when differential diagnosis is broad and complete information is needed.
The key distinction between codes 70551, 70552, and 70553 is purely what sequences were performed. If only non-contrast sequences were performed, use code 70551. If only post-contrast sequences were performed, use code 70552. If both non-contrast and post-contrast sequences were performed, use code 70553. The clinical indication does not determine code selection – only what imaging was actually performed.
| CPT Code | Contrast Protocol | What Is Performed | When to Use |
| 70551 | No contrast | Non-contrast sequences only | Complete study without gadolinium |
| 70552 | With contrast only | Post-contrast sequences only | Contrast given but no dedicated pre-contrast sequences |
| 70553 | Without and with contrast | Non-contrast sequences followed by contrast and post-contrast sequences | Complete protocol with both phases |
What Code 70553 Does NOT Include
Understanding what code 70553 does not cover prevents billing errors and helps identify when additional codes are needed.
Contrast Material Is Billed Separately
Code 70553 covers the imaging procedure including the technical work of performing the MRI and the professional work of interpreting the images. The gadolinium contrast material itself is not included and must be billed separately using HCPCS codes. This is one of the most common billing errors where radiology practices bill only the imaging code and fail to capture revenue for expensive contrast agents.
Gadolinium contrast agents used for brain MRI include various formulations each with specific HCPCS codes. Common agents include Gadopentetate dimeglumine or Magnevist (HCPCS code A9579 or Q9953 depending on formulation and payer), Gadobutrol or Gadavist (A9585), Gadoterate meglumine or Dotarem (A9575), Gadoteridol or ProHance (A9576), and Gadobenate dimeglumine or MultiHance (A9577).
These contrast agents are billed per milliliter administered. A typical brain MRI uses 10 to 20 milliliters of contrast depending on patient weight and specific product used. The dose administered must be documented in the medical record to support billing.
Failing to bill contrast materials means practices lose substantial revenue. Gadolinium agents cost practices money to purchase, and insurance companies reimburse for these agents separately from the imaging procedure. Across hundreds of contrast MRI studies monthly, missed contrast billing costs practices significant amounts in lost legitimate revenue annually.
MR Angiography Is a Separate Procedure
Magnetic resonance angiography (MRA) of intracranial vessels is a separate procedure from standard brain MRI. MRA uses specialized sequences to visualize blood vessels and blood flow. When MRA of intracranial circulation is performed in addition to standard brain MRI, both procedures are billed separately.
Intracranial MRA codes include code 70544 for MR angiography of head without contrast, code 70545 for MR angiography of head with contrast, and code 70546 for MR angiography of head without and with contrast. These codes are separate from brain MRI codes and bill in addition to brain MRI when both studies are performed.
For example, a patient with suspected stroke undergoes brain MRI without and with contrast (code 70553) plus MR angiography of intracranial circulation without contrast (code 70544) to evaluate vessels. Both codes are billed for this comprehensive study.
Functional MRI Uses Different Codes
Functional MRI (fMRI) which maps brain activity by detecting changes in blood flow uses different codes from standard anatomic brain MRI. When fMRI is performed, it is coded separately with code 70555 for fMRI of brain.
Standard anatomic brain MRI with code 70553 can be performed on the same day as fMRI with both studies billed separately when documentation supports medical necessity for both.
Perfusion and Spectroscopy Are Separate
Advanced MRI techniques like perfusion imaging and MR spectroscopy are separate from standard brain MRI. Perfusion imaging assesses blood flow and volume in brain tissues. MR spectroscopy analyzes brain metabolism by detecting different chemical compounds.
When these advanced techniques are performed in addition to standard brain MRI, they may be billed separately depending on payer policies and whether they are performed as distinct studies versus integrated into the standard MRI protocol.
The Professional and Technical Components
Like most imaging codes, code 70553 includes both professional and technical components that can be billed separately when performed by different entities.
Technical component (modifier TC) covers the technical work and expense of performing the MRI including equipment, technologist time, supplies, overhead, and contrast administration. The facility performing the scan bills the technical component.
Professional component (modifier 26) covers the radiologist’s work of interpreting the images and generating the written report. The radiologist or physician group bills the professional component.
Global service (no modifier) includes both components billed together when one entity performs both the imaging and interpretation. Freestanding radiology practices that own their MRI scanners and employ radiologists bill globally.
In hospital settings, the hospital typically bills the technical component (70553-TC) while hospital-based radiologists bill the professional component (70553-26) separately. Both components together equal the global service.
Documentation Requirements for Billing Code 70553
Proper documentation supports the code billed, establishes medical necessity, and protects against audit denials. For code 70553, specific documentation elements must exist in the medical record.
Physician Order Requirements
Every MRI must have a physician order. The order establishes medical necessity and authorizes the imaging study. The order must include the ordering physician’s name and signature, the specific study ordered using clear language such as “MRI brain without and with contrast,” the clinical indication explaining why the MRI is needed including relevant symptoms, suspected diagnoses, or clinical questions, relevant clinical history providing context, and any special instructions or protocol modifications.
The order should be in the medical record before the MRI is performed. Standing orders or protocols are acceptable when they specify clinical situations where the protocol applies and are properly documented in the medical record.
Vague orders like “MRI brain” without specifying contrast protocol create coding ambiguity. The order should clearly state whether the study should be performed without contrast, with contrast only, or without and with contrast. This helps the imaging facility perform the appropriate protocol and bill correctly.
Radiology Report Requirements
The radiologist interpretation must be documented in a complete written report. This report justifies billing the professional component of code 70553 and must include mandatory elements.
The clinical indication should restate why the exam was ordered, either copying from the order or paraphrasing the clinical question being addressed. The technique section should describe how the exam was performed including the imaging equipment used, the brain region imaged, confirmation that imaging was performed without contrast followed by contrast administration and post-contrast imaging, the type and dose of contrast material administered, and any special sequences or protocols used.
The findings section represents the core of the report and must describe brain anatomy and any pathology identified. The description should be detailed enough to show the radiologist actually reviewed all acquired images. For code 70553 specifically, the findings should reference
both non-contrast and post-contrast sequences, describing what was seen on each. The report should note any areas showing abnormal enhancement on post-contrast images compared to non-contrast images.
The impression section should summarize key findings and provide diagnostic conclusions. This section answers the clinical question and guides treatment decisions. The impression should list all significant findings in order of importance and recommend additional imaging or follow-up only when medically appropriate.
The report must be signed by the interpreting radiologist with electronic or written signature. The signature date should reflect when interpretation was completed. Unsigned reports are incomplete and cannot support professional component billing.
Contrast Documentation Specifics
When billing code 70553, documentation must clearly establish that both non-contrast and post-contrast imaging were performed. The technique section should explicitly state that
non-contrast sequences were acquired first, then contrast was administered, then post-contrast sequences were acquired.
Documentation of the contrast material administered should include the specific contrast agent name, the dose in milliliters, the route of administration which is always intravenous for brain MRI, and any adverse reactions if they occurred or statement that the procedure was tolerated without complications.
This contrast documentation supports both the imaging code 70553 and the separate billing of contrast material with HCPCS codes. Without documented contrast administration, code 70553 cannot be supported.
Medical Necessity Documentation
The overall medical record should support that the MRI was medically necessary. The patient chart should document symptoms or clinical findings warranting advanced imaging such as new neurological deficits, severe or changing headache patterns, seizures, mental status changes, or other concerning symptoms.
Physical examination findings should be documented supporting the need for imaging when relevant. Prior imaging results should be referenced when MRI is being performed for follow-up or further evaluation of known abnormalities.
Medical necessity denials often stem from inadequate documentation of why MRI was needed rather than less expensive alternatives, why contrast was medically necessary rather than performing only non-contrast imaging, why MRI is needed before trying conservative treatment for benign conditions, or why repeat MRI is needed so soon after a previous study.
Documentation Failures That Cause Problems
Common documentation deficiencies include technique sections that do not clearly state both non-contrast and post-contrast sequences were performed, no documentation of specific contrast agent administered or dose given, findings that do not reference both non-contrast and post-contrast images, vague clinical indications like “headache” without further description of concerning features, unsigned reports, and billing code 70553 when documentation shows only post-contrast sequences were performed which supports code 70552 not 70553.
Common Billing Errors and How to Avoid Them
Understanding frequent mistakes helps practices avoid them and protects against denials and compliance problems.
Error 1: Using 70553 When Only Post-Contrast Imaging Performed
Billing code 70553 when the MRI protocol included only post-contrast sequences without dedicated non-contrast sequences is incorrect. Code 70553 specifically requires both
non-contrast and post-contrast imaging. When only post-contrast imaging is performed, code 70552 applies.
This error typically occurs when radiologists perform abbreviated follow-up protocols that omit non-contrast sequences but billing staff assume all contrast MRI studies use code 70553. The code must match what was actually performed, not what is typically performed.
The fix: Review the actual sequences performed before coding. If the protocol included both non-contrast and post-contrast sequences, bill code 70553. If only post-contrast sequences were performed, bill code 70552. The radiology report technique section should clearly document which sequences were performed.
Error 2: Not Billing Contrast Material Separately
Billing only code 70553 without billing the gadolinium contrast agent separately means practices lose revenue. The imaging code covers only the procedure. Contrast materials are billed separately with HCPCS codes.
This error happens when billing staff do not realize contrast is a separate billable supply or when there is poor communication between the imaging department and billing department about what contrast was actually used.
The fix: Bill both the imaging code 70553 and the appropriate HCPCS code for the specific contrast agent administered. Document the contrast type and dose in the procedure record. Implement systems that automatically generate contrast charges when contrast studies are performed.
Error 3: Using 70553 for Non-Contrast Studies
Billing code 70553 when no contrast was administered is incorrect. Code 70553 requires contrast administration. Studies performed entirely without contrast use code 70551.
This error can occur when orders request “brain MRI without and with contrast” but the patient has contraindications discovered at the time of imaging and contrast is not administered. If the study proceeded as non-contrast only, code 70551 should be billed not 70553.
The fix: Code based on what was actually performed. If contrast was not administered for any reason, bill code 70551 for non-contrast brain MRI. Only bill code 70553 when contrast was actually given and post-contrast sequences were performed.
Error 4: Billing Multiple Brain MRI Codes Same Day
Billing multiple brain MRI codes like 70551 and 70553 for the same imaging session is incorrect. These codes are mutually exclusive. One brain MRI examination uses one code based on the contrast protocol performed.
This error might occur if non-contrast sequences are performed, then the radiologist decides contrast is needed and post-contrast sequences are added. This is still one examination billed with code 70553, not separate billing of 70551 for the non-contrast portion and 70552 for the contrast portion.
The fix: Bill one brain MRI code per examination based on the complete protocol performed. If both non-contrast and post-contrast sequences were performed during one session, bill only code 70553 which covers both phases.
Error 5: Billing 70553 Without Documentation of Both Phases
Billing code 70553 when documentation does not clearly support that both non-contrast and post-contrast sequences were performed creates audit risk. The radiology report must document both phases to support code 70553.
This error happens when radiologists use template language that does not specify sequences performed or when technique sections are vague about what imaging was actually done.
The fix: Radiology reports for code 70553 studies must clearly document in the technique section that non-contrast sequences were performed followed by contrast administration and post-contrast sequences. Be specific about what was done.
Error 6: Incorrect Modifier Usage
Billing code 70553 with inappropriate modifiers or without required modifiers causes processing errors. Modifier 26 for professional component and modifier TC for technical component should
be used when components are billed separately. No modifier is used when billing the global service.
Common modifier errors include billing the global code with modifier 26 or TC when the billing entity performed both components, billing technical component without modifier TC, or billing professional component without modifier 26.
The fix: Use modifier 26 when billing only the professional component (radiologist interpretation). Use modifier TC when billing only the technical component (facility imaging). Use no modifier when billing the global service including both components.
Error 7: Billing Contrast Reactions Incorrectly
When patients have allergic reactions or other adverse events related to contrast administration, these are not coded or billed as separate services. The management of contrast reactions is included in the imaging service and in the facility’s emergency services if extensive intervention is required.
Do not bill separate E/M codes or procedure codes for managing minor contrast reactions during imaging. If the reaction requires extensive emergency department level care, that care is billed separately through ED visit codes, not through additional imaging-related codes.
The fix: Manage minor contrast reactions as part of the imaging service without separate billing. Document reactions thoroughly. If reactions require extensive care, that care is billed appropriately through ED or other encounter codes, not through manipulation of imaging codes.
Medical Necessity and Appropriate Use of Code 70553
Every imaging service billed must be medically necessary. For code 70553, medical necessity means the patient’s clinical situation warranted brain MRI with both non-contrast and contrast imaging based on symptoms, examination findings, suspected diagnoses, and evidence-based imaging guidelines.
Appropriate Clinical Indications for Brain MRI With Contrast
Code 70553 is appropriate for numerous conditions where contrast enhancement provides diagnostic value beyond non-contrast imaging alone. Brain tumor evaluation benefits from contrast because tumors typically enhance due to breakdown of the blood-brain barrier.
Contrast helps distinguish tumor from surrounding edema, identifies tumor margins, and differentiates tumor types. Metastatic disease screening uses contrast to detect small enhancing lesions throughout the brain that might not be visible without contrast.
Infection including brain abscess, meningitis, and encephalitis benefits from contrast imaging because inflamed and infected tissues enhance. Contrast helps identify abscess capsules, meningeal enhancement, and parenchymal involvement. Inflammatory conditions including
multiple sclerosis use contrast to identify active inflammatory lesions which enhance acutely while chronic inactive lesions do not enhance. Contrast distinguishes active disease requiring treatment from stable disease.
Vascular malformations including arteriovenous malformations and cavernous malformations are better characterized with contrast imaging. Post-operative imaging after brain surgery uses contrast to distinguish post-surgical enhancement from tumor recurrence. Pituitary abnormalities benefit from contrast though dedicated pituitary protocols may use separate codes.
When Non-Contrast Imaging Alone May Be Sufficient
Some clinical situations may warrant only non-contrast brain MRI without need for contrast administration. Acute stroke evaluation primarily uses non-contrast sequences including diffusion-weighted imaging to detect acute ischemia. Contrast may be added if vascular imaging is needed but basic stroke protocol can be non-contrast only.
Chronic headache evaluation in low-risk patients without concerning features may warrant
non-contrast imaging only to exclude structural abnormalities. Trauma evaluation assessing for hemorrhage and injury typically uses non-contrast imaging. Screening for seizure causes may use non-contrast imaging in some protocols.
Patients with contraindications to gadolinium including severe renal insufficiency or prior severe allergic reactions receive non-contrast imaging when contrast cannot safely be administered.
Frequency and Repeat Imaging
Repeat brain MRI studies must be medically justified. Routine surveillance imaging for stable conditions may be appropriate at intervals determined by evidence-based guidelines and clinical judgment. New symptoms, clinical changes, or progression of known disease may warrant repeat imaging sooner than routine surveillance intervals.
Documentation should explain why repeat imaging is needed and justify the interval since prior imaging. Simply noting “routine follow-up MRI” may not adequately establish medical necessity without more specific clinical context.
Comparing Code 70553 to Other Neuroimaging Codes
Understanding how code 70553 differs from other brain and head imaging procedures helps with correct code selection.
70553 vs 70450-70470: Brain MRI vs Brain CT
Brain CT codes 70450 (without contrast), 70460 (with contrast), and 70470 (without and with contrast) describe computed tomography rather than MRI. These are completely different imaging modalities.
CT uses radiation and provides faster imaging but lower soft tissue contrast compared to MRI. CT is preferred for acute trauma, acute hemorrhage detection, and situations where MRI is contraindicated or unavailable. MRI provides superior soft tissue detail and is preferred for most brain pathology evaluation including tumors, inflammation, infection, demyelination, and detailed anatomic assessment.
Both CT and MRI can be appropriate depending on clinical situation. They are separate services with separate codes. Do not confuse CT codes with MRI codes.
70553 vs 70543-70546: Brain MRI vs MRA Brain
Code 70553 covers anatomic brain MRI. Codes 70544, 70545, and 70546 cover MR angiography of intracranial circulation which visualizes blood vessels rather than brain parenchyma. These are separate studies serving different purposes.
When both anatomic brain MRI and MRA of brain vessels are performed, both codes are billed separately. A patient with stroke undergoes brain MRI to evaluate parenchyma (code 70553) and MRA to evaluate vessels (code 70544 or other MRA code depending on protocol). Both studies are medically necessary and separately billable.
70553 vs 70555: Brain MRI vs Functional MRI
Code 70553 covers standard anatomic brain MRI. Code 70555 covers functional MRI (fMRI) which maps brain activity. These are different studies with different purposes.
Functional MRI is performed for pre-surgical brain mapping, evaluation of eloquent cortex location, and research purposes. It is separate from anatomic imaging and billed separately when performed.
70553 vs Temporal Bone and Pituitary Imaging
Imaging of temporal bones, internal auditory canals, cerebellopontine angles, and pituitary gland uses separate codes from standard brain MRI even though these structures are in the head.
Dedicated pituitary MRI protocols use codes 70551-70553 with the understanding that the focus is pituitary, or may use different codes depending on payer and protocol specifics. Dedicated temporal bone and internal auditory canal imaging uses separate codes.
When standard brain MRI is performed separately from dedicated specialized head imaging, both can be billed if documentation supports medical necessity for both.
| Code | Imaging Type | What It Shows | When Used Instead of 70553 |
| 70551 | Brain MRI without contrast | Brain anatomy without enhancement | When contrast not needed or contraindicated |
| 70552 | Brain MRI with contrast only | Enhancement patterns | When only post-contrast imaging performed |
| 70553 | Brain MRI without and with | Complete anatomic and enhancement assessment | Standard comprehensive brain MRI |
| 70450 | Brain CT without contrast | Brain anatomy using CT | Fast imaging, trauma, when MRI unavailable |
| 70544 | MRA brain without contrast | Intracranial blood vessels | Vascular evaluation |
| 70555 | Functional MRI brain | Brain activity mapping | Pre-surgical planning, eloquent cortex mapping |
Conclusion
CPT code 70553 represents magnetic resonance imaging of brain including brainstem performed without contrast material followed by contrast material administration and further post-contrast sequences. This code describes the most comprehensive brain MRI protocol including both non-contrast imaging for anatomic detail and contrast-enhanced imaging for assessment of enhancement patterns.
The code requires that both phases are performed during the same imaging session.
Non-contrast sequences must be acquired first, followed by intravenous gadolinium administration, followed by post-contrast sequences. If only non-contrast imaging is performed, code 70551 applies. If only post-contrast imaging is performed, code 70552 applies. If both are performed, code 70553 applies.
Documentation requirements include physician order specifying the study and clinical indication, radiology report with technique section documenting both non-contrast and post-contrast sequences were performed, findings section describing pathology identified on both phases, specific documentation of contrast agent type and dose administered, and signed interpretation by the radiologist.
Contrast materials must be billed separately from the imaging procedure using appropriate HCPCS codes for the specific gadolinium agent administered. Failing to bill contrast separately means practices lose substantial legitimate revenue.
Common billing errors include using code 70553 when only post-contrast imaging was performed (should use 70552), not billing contrast materials separately, using 70553 for
non-contrast studies (should use 70551), billing multiple brain MRI codes for one examination, billing 70553 without documentation supporting both imaging phases, incorrect modifier usage when billing components separately, and inadequate documentation of medical necessity.
Technical and professional components can be billed separately when performed by different entities using modifier TC and modifier 26 respectively. Global billing without modifiers applies when one entity performs both components.
Understanding what code 70553 covers, when to use it versus related brain MRI codes, what documentation must exist, how to bill contrast separately, and how to avoid common errors protects practices from audit problems and claim denials while capturing appropriate revenue for brain MRI services provided. The code selection depends solely on what imaging was actually performed, not on clinical indication or what was originally ordered, making accurate documentation of imaging protocols performed absolutely essential for correct billing.
