Summary & Overview
CPT 70551: MRI of the Brain Without Contrast
CPT code 70551 is a widely utilized billing code for magnetic resonance imaging (MRI) of the brain, performed without the use of contrast material. This diagnostic radiology procedure is essential for evaluating a range of neurological conditions, including headaches, vertigo, epilepsy, and cerebrovascular diseases. The code is recognized nationally and is covered by major payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, reflecting its importance in both clinical and reimbursement contexts.
This publication provides a comprehensive overview of 70551, including payer coverage, clinical indications, and related billing codes. Readers will gain insight into the typical sites of service, such as hospital outpatient departments and imaging centers, and understand the role of this procedure in the broader landscape of diagnostic imaging for the head and neck. The summary also highlights relevant modifiers and associated taxonomies, offering clarity on billing practices and policy updates. Benchmarks and clinical context are discussed to inform stakeholders about utilization trends and regulatory considerations. The information is presented for a national audience, supporting healthcare professionals, administrators, and policy analysts in navigating the complexities of medical billing and coverage for brain MRI procedures.
CPT Code Overview
CPT code 70551 represents magnetic resonance imaging (MRI) of the brain (including brain stem) without contrast material. This procedure is a key diagnostic radiology service used to evaluate neurological conditions and abnormalities within the brain. It is commonly performed in advanced imaging facilities, such as hospital outpatient departments or dedicated imaging centers. The service is part of the broader category of Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck, providing clinicians with detailed images to support diagnosis and treatment planning.
Clinical & Coding Specifications
Clinical Context
A patient presents to an advanced imaging facility, such as a hospital outpatient department or imaging center, with symptoms including persistent headache, episodes of vertigo, or unexplained neurological changes. The ordering physician, often a neurologist or primary care provider, requests a magnetic resonance imaging (MRI) of the brain without contrast to evaluate for possible structural abnormalities, cerebrovascular disease, or seizure disorders. The procedure is performed by a radiologist specializing in diagnostic radiology, neuroradiology, or pediatric radiology, depending on the patient's age and clinical presentation. The MRI is used to assess the brain and brain stem for conditions such as epilepsy, cerebrovascular disease, or other unspecified brain disorders.
Coding Specifications
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Modifiers:
GA: Waiver of Liability Statement Issued as Required by Payer Policy (expectation of denial; ABN on file)GX: Notice of Liability Issued, Voluntary Under Payer PolicyGZ: Item or service expected to be denied as not reasonable and necessary; no ABN on file
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Provider Taxonomies:
2085R0202X: Radiology, Diagnostic Radiology2085N0700X: Radiology, Neuroradiology2085P0229X: Radiology, Pediatric Radiology
| Modifier | Description |
|---|---|
GA | Waiver of Liability Statement Issued as Required by Payer Policy (expectation of denial; ABN on file) |
GX | Notice of Liability Issued, Voluntary Under Payer Policy |
GZ | Item or service expected to be denied as not reasonable and necessary; no ABN on file |
| Taxonomy Code | Specialty |
|---|---|
2085R0202X | Radiology, Diagnostic Radiology |
2085N0700X | Radiology, Neuroradiology |
2085P0229X | Radiology, Pediatric Radiology |
Related Diagnoses
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G93.9: Disorder of brain, unspecified- Used when the patient has symptoms or findings suggestive of a brain disorder without a specific diagnosis. MRI helps in further evaluation.
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R51: Headache- Common indication for brain MRI to rule out structural causes of headache.
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H81.13: Benign paroxysmal vertigo, bilateral- MRI may be ordered to exclude central causes of vertigo.
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G40.909: Epilepsy, unspecified, not intractable, without status epilepticus- MRI is used to assess for structural abnormalities in patients with epilepsy.
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I67.89: Other cerebrovascular disease- MRI is indicated to evaluate for cerebrovascular pathology such as small vessel disease or prior strokes.
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
G93.9 | Disorder of brain, unspecified | MRI used for evaluation of unexplained neurological symptoms |
R51 | Headache | MRI used to rule out structural causes |
H81.13 | Benign paroxysmal vertigo, bilateral | MRI used to exclude central causes |
G40.909 | Epilepsy, unspecified, not intractable, without status epilepticus | MRI used to assess for structural abnormalities |
I67.89 | Other cerebrovascular disease | MRI used to evaluate cerebrovascular pathology |
Related CPT Codes
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70541: Magnetic resonance angiography (MRA) of the brain- Used to evaluate cerebral blood vessels. May be performed in addition to
70551when vascular pathology is suspected.
- Used to evaluate cerebral blood vessels. May be performed in addition to
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0865T: Add-on code for automated detection and quantification of brain MRI- Applied when advanced software is used for automated analysis during the MRI procedure. Used in conjunction with
70551.
- Applied when advanced software is used for automated analysis during the MRI procedure. Used in conjunction with
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0866T: Add-on code for automated detection and quantification of brain MRI- Similar to
0865T, this add-on code is used for automated quantification. Used alongside70551.
- Similar to
| CPT Code | Description | Clinical Relationship |
|---|---|---|
70541 | Magnetic resonance angiography (MRA) of the brain | Alternative or additional study for vascular assessment |
0865T | Add-on code for automated detection and quantification of brain MRI | Used with 70551 for advanced analysis |
0866T | Add-on code for automated detection and quantification of brain MRI | Used with 70551 for advanced analysis |
National Reimbursement Benchmarks
National mean rates for CPT code 70551 show a significant gap between Medicare and commercial payers. Medicare's mean rate is $135.45, while the average commercial mean rate (BUCA) is $240.25, representing a difference of $104.80 per service.
Rate dispersion varies notably across payers. Cigna exhibits the widest spread, with a difference of $191.09 between its 75th and 25th percentiles, indicating substantial variability in contracted rates. In contrast, BUCA has a tighter range of $117.29, suggesting more consistent rates across its network. The table and chart below present the full breakdown of national benchmarks for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.