CPT 70557Radiology

Mri brain w/o dye

CPT code 70557 is used for an MRI scan of the brain performed without contrast dye or injectable materials. This is a non-invasive imaging test that uses magnetic fields to create detailed pictures of brain structures.

Showing rates for

National Average

Base Medicare rate

$145.56

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

2.9

PE RVU (NF)

1.47

MP RVU

0.13

Total RVU

4.5

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

NCCI bundling edits

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Billing tips

Always verify whether contrast was administered before coding; 70557 is non-contrast only, while 70553 includes contrast
Impact: Miscoding between 70553 ($198 avg) and 70557 ($145.56) creates $52+ payment variance and high audit risk
Split billing between professional (26) and technical (TC) components based on your practice arrangement
Impact: Hospital-based radiologists typically bill 26 modifier only; freestanding centers bill global to maximize the full $145.56
Document medical necessity explicitly in ordering physician notes, linking to specific symptoms or differential diagnoses
Impact: Prevents 30-40% of prior authorization denials and reduces post-payment audit recoupment risk
Verify Medicare LCD requirements for your MAC jurisdiction before performing studies for screening indications
Impact: Non-covered screenings without ABN result in 100% write-off; proper ABN allows patient billing
Submit claims with appropriate ICD-10 codes that support medical necessity; avoid outdated or non-specific codes
Impact: Claims with non-specific codes (R51.9 headache) face 25-35% higher denial rates than specific diagnoses
Check for frequency limitations in Medicare policy; repeat brain MRIs within 30-90 days often require peer-to-peer review
Impact: Proactive peer review reduces claim denial from 60% to under 15% for repeat studies

Common denials

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Frequently asked questions

What is the difference between CPT 70557 and 70553?

CPT 70557 is brain MRI without contrast material ($145.56 Medicare rate), while 70553 is brain MRI with contrast material ($198+ Medicare rate). Code 70557 is used when no intravenous contrast dye is administered during the scan. The choice depends on clinical indication and physician order specifications.

How much does Medicare pay for CPT 70557 in 2025?

Medicare pays $145.56 for CPT 70557 in 2025 based on the national average non-facility rate. This represents 4.5 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality and whether professional or technical component is billed.

Does CPT 70557 require prior authorization?

Prior authorization requirements for CPT 70557 vary by payer and state. Most Medicare Advantage plans require prior authorization for brain MRI. Traditional Medicare increasingly requires prior authorization through the Appropriate Use Criteria program. Commercial payers typically require authorization except for specific urgent indications. Always verify with the specific payer before scheduling.

Can I bill CPT 70557 with modifier 26 for reading only?

Yes, modifier 26 should be appended to 70557 when billing only the professional component (physician interpretation and report). This is common for hospital-employed radiologists who read studies but don't own the equipment. The technical component (equipment, technologist, supplies) is billed separately by the facility with modifier TC.

What diagnosis codes support medical necessity for CPT 70557?

Common supporting diagnosis codes include G43.x (migraine), G40.x (epilepsy), R41.0 (disorientation/confusion), G89.x (headache), I63.x (cerebral infarction), G35 (multiple sclerosis), and R56.9 (seizure). Payers typically deny non-specific codes like R51 (headache) without additional clinical documentation of red flag symptoms or failed conservative treatment.

How many RVUs is CPT code 70557 worth in 2025?

CPT 70557 has 4.5 total RVUs in 2025, consisting of 2.9 work RVUs, 1.47 practice expense RVUs (both facility and non-facility), and 0.13 malpractice RVUs. These RVU values are multiplied by the conversion factor (32.3465) to calculate the Medicare payment rate of $145.56.

What is the global period for CPT 70557?

CPT 70557 has a global period of XXX (global concept does not apply), as it is a diagnostic imaging service rather than a surgical procedure. There are no pre-operative or post-operative days bundled into the service. E/M services on the same day are separately billable with appropriate documentation.