Summary & Overview
CPT 70553: MRI of the Brain with and without Contrast
CPT code 70553 is a widely utilized billing code for magnetic resonance imaging (MRI) of the brain, including the brain stem, performed both without and with contrast material. This diagnostic imaging procedure is essential for evaluating a variety of neurological conditions, such as headaches, epilepsy, vertigo, and cerebrovascular diseases. The code is recognized and reimbursed by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, underscoring its importance in clinical practice and coverage policies.
This publication provides a comprehensive overview of CPT 70553, detailing its clinical applications, typical sites of service, and associated billing practices. Readers will gain insights into payer coverage, common modifiers, and relevant taxonomies, as well as the ICD-10 diagnoses frequently linked to this procedure. The analysis also highlights related CPT codes for brain and head imaging, offering context for how CPT 70553 fits within broader radiology billing and policy frameworks. Key benchmarks and policy updates are discussed to inform stakeholders about current trends and requirements in diagnostic imaging reimbursement. The summary is designed for healthcare professionals, billing specialists, and policy analysts seeking up-to-date information on MRI brain imaging services.
CPT Code Overview
CPT 70553 represents magnetic resonance imaging (MRI) of the brain, including the brain stem, performed without contrast material, followed by contrast material(s) and further sequences. This procedure is a key diagnostic imaging service used to evaluate neurological conditions and abnormalities within the brain. The service type is Radiology (Diagnostic Imaging), and it is typically performed in a hospital outpatient setting (POS 22) or an office (POS 11). MRI scans using this code provide detailed images that assist clinicians in diagnosing a wide range of neurological disorders and guiding patient management.
Clinical & Coding Specifications
Clinical Context
A patient presents to the hospital outpatient department or physician office with symptoms such as persistent headache, unexplained vertigo, or episodes of seizure. The clinician suspects a neurological disorder and orders a magnetic resonance imaging (MRI) of the brain, including the brain stem. The procedure is performed first without contrast, then with contrast material, followed by additional imaging sequences to enhance diagnostic accuracy. The radiologist interprets the images to evaluate for conditions such as cerebrovascular disease, epilepsy, or other brain disorders.
Coding Specifications
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Modifiers:
- Modifier
26: Used when reporting only the professional component (interpretation of the images) of the MRI procedure. - Modifier
TC: Used when reporting only the technical component (performance of the imaging and provision of equipment) of the MRI procedure. - Modifier
59: Used to indicate a distinct procedural service, typically when multiple procedures are performed that are not normally reported together.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
2085R0202X | Diagnostic Radiology |
2086P0201X | Neurology—Diagnostic Radiology |
- Specialties Represented:
- Diagnostic Radiology: Physicians specializing in imaging interpretation and performance.
- Neurology—Diagnostic Radiology: Physicians with expertise in neurological imaging.
Related Diagnoses
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G93.9: Disorder of brain, unspecified- Relevant for patients with undifferentiated neurological symptoms requiring brain imaging.
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R51: Headache- Common indication for brain MRI to rule out structural causes.
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H81.13: Benign paroxysmal vertigo, bilateral- MRI may be used to exclude central causes of vertigo.
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G40.909: Epilepsy, unspecified, not intractable, without status epilepticus- MRI is indicated to evaluate for structural brain abnormalities in epilepsy.
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I67.89: Other cerebrovascular disease- MRI is used to assess for cerebrovascular pathology such as stroke or vascular malformations.
Related CPT Codes
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70551: Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material.- Used when only non-contrast MRI is performed. Alternative to
70553when contrast is not required.
- Used when only non-contrast MRI is performed. Alternative to
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70552: Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s).- Used when only contrast-enhanced MRI is performed. May be used in conjunction with or as an alternative to
70553depending on clinical need.
- Used when only contrast-enhanced MRI is performed. May be used in conjunction with or as an alternative to
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70540-70543: Magnetic resonance imaging of the orbit, face, and/or neck (MRI study of the orbit, face, and/or neck).- Related when imaging extends beyond the brain to adjacent structures. May be performed together if clinical symptoms involve these regions.
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70545: Magnetic resonance angiography, head.- Used for vascular imaging of the head. May be ordered alongside
70553when vascular pathology is suspected.
- Used for vascular imaging of the head. May be ordered alongside
National Reimbursement Benchmarks
National mean rates for CPT code 70553 show a significant gap between Medicare and commercial payers. Medicare's mean rate is $219.85, while the BUCA (average commercial) mean rate is $364.40, highlighting a difference of $144.55 per service.
Rate dispersion varies notably across payers. Aetna has the tightest range between the 25th and 75th percentiles ($109.43), indicating less variability in contracted rates. Cigna and UnitedHealth Group display the widest dispersions, with Cigna's range at $304.33 and UnitedHealth Group's at $254.28, reflecting broader variability in commercial reimbursement.
The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.
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.