Brain and brainstem MRI performed in one session with non-contrast sequences followed by sequences after gadolinium contrast.
- Medicare
- $316.97
- Work RVU
- 2.23
- 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 explaining the need for contrast
- Neurologic findings or cancer history
- Gadolinium agent, dose, and timing
- Report describing pre and post contrast sequences
- Authorization covering each region scanned
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 ↓
70553 is the full brain MRI with sequences before and after contrast. It is the most common contrast brain protocol and is used for tumors, metastases, infection, and demyelinating disease.
For spine and orthopedic oncology patients, this is the staging brain study. It also comes up when a myelopathy workup needs to rule out MS, where contrast helps show active lesions. The spine surgeon may order it, but more often oncology or neurology does.
Do not bill 70551 with 70552 for one session. That pair is bundled, and 70553 is the correct single code. If the brain and the whole spine are imaged in one visit for MS or metastatic disease, each region is a separate code with its own contrast designation. Authorization from a radiology benefit manager often lists each region separately, so check that every billed code is on the approval.
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 (2.23) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.49) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 2.23 |
| Practice expense RVU | 7.1 |
| Malpractice RVU | 0.16 |
| Total RVU | 9.49 |
| Medicare national rate | $316.97 |
| 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 | $316.97 |
HOPD (APC 5572) Hospital outpatient department | $356.43 |
Common denial reasons
The recurring reasons claims for CPT 70553 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- 70551 and 70552 billed for the same session
- Authorization did not include the brain when spine regions were approved
- Contrast not given, so 70551 was correct
- Diagnosis does not support a contrast study
- Repeat imaging without a new clinical reason
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Can 70551 and 70552 be billed together?
02Can brain and spine MRI be billed on the same day?
03What diagnosis supports 70553 in a spine patient?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe documents the neurologic exam and cancer history in the spine visit, giving the brain MRI order the indication payers look for.
See how Mira captures CPT 70553 documentation