CPT 70552Radiology

Mri brain stem w/dye

CPT code 70552 is used when a patient receives an MRI scan of the brain stem (the part connecting the brain to the spinal cord) using contrast dye injected into the bloodstream to create clearer, more detailed images.

Showing rates for

National Average

Base Medicare rate

$266.54

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.78

PE RVU (NF)

6.35

MP RVU

0.11

Total RVU

8.24

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always verify contrast was actually administered and documented in the medical record before billing 70552 instead of 70551 (without contrast)
Impact: Incorrect contrast coding results in overpayment issues and potential audit liability; 70552 pays approximately $50-70 more than 70551
Document medical necessity for contrast enhancement specifically - explain why non-contrast imaging is insufficient for the clinical question
Impact: Prevents denials for lack of medical necessity; failure to justify contrast can trigger downcoding to 70551 with recovery of overpayment
Do not bill 70552 with 70553 (MRI brain stem without and with contrast) for the same session - 70553 is the comprehensive code that includes both
Impact: Prevents $266.54 overpayment and unbundling denials; 70553 should be billed when both without and with contrast images are medically necessary
For split billing (hospital technical/physician professional), ensure modifier 26 or TC is appended to avoid duplicate payment issues
Impact: Prevents overpayment flags and claim rejections; ensures proper facility vs. professional payment allocation
Verify that ordering physician's diagnosis codes support medical necessity for contrast-enhanced MRI per LCD/NCD requirements
Impact: Prevents medical necessity denials; approximately 15-20% of advanced imaging denials relate to inadequate diagnosis code support
Check for prior authorization requirements before performing procedure; many commercial payers require pre-certification for advanced imaging
Prevents complete denial of $266.54 claim; retroactive authorization attempts have low success rates (typically under 30%)

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Frequently asked questions

What is the difference between CPT 70552 and 70551?

CPT 70552 is for MRI brain stem with contrast dye, while 70551 is without contrast. Code 70552 requires intravenous injection of gadolinium contrast material and pays $266.54 compared to approximately $200-220 for 70551. Use 70552 only when contrast is medically necessary and actually administered.

How much does Medicare pay for CPT code 70552 in 2025?

Medicare pays $266.54 for CPT 70552 in 2025 based on the national average rate. This amount applies to both facility and non-facility settings. The code has 8.24 total RVUs (1.78 work RVU, 6.35 practice expense RVU, 0.11 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can you bill 70552 and 70551 together?

No, you should not bill 70552 and 70551 together for the same session. If both non-contrast and contrast sequences are performed, the correct code is 70553 (MRI brain stem without contrast followed by with contrast). Billing both 70551 and 70552 separately is considered unbundling and will result in denial.

What diagnosis codes support medical necessity for CPT 70552?

Common supporting diagnoses include brain stem tumors, multiple sclerosis, acoustic neuroma, vascular malformations, unexplained cranial nerve palsies, posterior fossa lesions, and suspected metastatic disease. Payers typically require diagnosis codes indicating pathology that specifically benefits from contrast enhancement rather than routine screening indications.

Does CPT 70552 require prior authorization?

Prior authorization requirements vary by payer. Medicare typically does not require prior authorization for 70552 but may require compliance with appropriate use criteria under certain programs. Most commercial payers and Medicare Advantage plans do require prior authorization for advanced imaging including 70552. Always verify with the specific payer before performing the procedure.

What modifiers are commonly used with CPT 70552?

The most common modifiers are 26 (professional component only) and TC (technical component only) for split billing. Modifier 59 may be needed for distinct procedural services, 76 for repeat procedures by same physician, and 91 for repeat diagnostic procedures. Modifier KX may be required by some Medicare contractors to indicate medical policy compliance.

How do you document medical necessity for contrast in CPT 70552?

Document specific clinical findings that require contrast enhancement such as suspected tumor characterization, evaluation of enhancement patterns in known lesions, assessment of blood-brain barrier breakdown, or differentiation between recurrent tumor and post-treatment changes. The ordering physician should explain why non-contrast imaging is insufficient to answer the clinical question.