MRI of the orbit, face, or neck soft tissues performed only after a gadolinium contrast injection, without a non-contrast series in the same session.
- Medicare
- $266.54
- Work RVU
- 1.58
- Global, days
- Region
- Other
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Order naming orbit, face, or soft tissue neck
- Clinical reason for contrast, such as mass or infection
- Gadolinium agent and dose
- MRI safety screening, including implants and hardware
- Report confirming a post-contrast only study
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
70542 is an MRI of the orbit, face, or soft tissue neck with contrast only. It is used for masses, infections, and nerve or gland problems in that region. Like the CT neck codes, it does not cover the cervical spine.
An orthopedic or spine practice may see it when working up a neck mass found during a cervical spine evaluation, or when a brachial plexus or soft tissue tumor question extends into the neck. Cervical spine MRI is in the 72141 to 72158 range. If the surgeon wants the cord and discs, this is the wrong code.
The usual coding errors: a study done without and with contrast is 70543, not 70542. A non-contrast study is 70540. Prior authorization is almost always required by commercial plans for outpatient MRI, and an auth approved for a cervical spine MRI will not cover a neck soft tissue MRI.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (1.58) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.98) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.58 |
| Practice expense RVU | 6.29 |
| Malpractice RVU | 0.11 |
| Total RVU | 7.98 |
| Medicare national rate | $266.54 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $266.54 |
HOPD (APC 5572) Hospital outpatient department | $356.43 |
Common denial reasons
The recurring reasons claims for CPT 70542 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Study included pre-contrast images, so 70543 applies
- Authorization was for a cervical spine MRI code
- Diagnosis is spinal, not soft tissue
- Contrast not given but 70542 billed
- Missing modifier 26 in a facility setting
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Is 70542 used for cervical spine MRI?
02What is the difference between 70540, 70542, and 70543?
03Does 70542 need prior authorization?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
When a neck mass or soft tissue finding comes up during a spine visit, Mira Scribe documents it separately from the spinal complaint, so each imaging order has its own reason.
See how Mira captures CPT 70542 documentation