CPT 70558Radiology

Mri brain w/dye

CPT code 70558 covers an MRI (magnetic resonance imaging) scan of the brain performed with contrast dye injected into the bloodstream to enhance visibility of blood vessels, tumors, and other abnormalities.

Showing rates for

National Average

Base Medicare rate

$161.09

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

3.2

PE RVU (NF)

1.63

MP RVU

0.15

Total RVU

4.98

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

NCCI bundling edits

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Billing tips

Verify and document contrast administration in radiology report and nursing notes
Impact: Lack of contrast documentation causes downcoding to 70551, reducing payment by $30-40 (20-25% reduction)
Confirm medical necessity supports contrast use with documented indication in order and interpretation
Impact: Medicare and commercial payers increasingly require specific indications for contrast; lack of justification triggers denials affecting full $161.09 payment
Do not bill 70558 with 70551 (brain MRI without contrast) on same date unless both are medically necessary and documented
Impact: Bundling edits will deny one code; if both needed, bill 70553 (without and with contrast) instead at $226-240 range
Ensure facility is accredited and technologists are certified when billing Medicare
Impact: Non-accredited facilities face automatic denial of all claims; affects 100% of Medicare revenue
Split billing with modifier 26/TC only when physician and facility have separate tax IDs
Impact: Improper modifier use causes claim rejection or overpayment recovery; combined payment equals $161.09 total
Document and code contrast reactions or complications separately with appropriate E/M or procedure codes
Impact: Contrast reactions requiring treatment represent additional billable services worth $50-500 depending on severity

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 70558 in 2025?

The 2025 Medicare national average payment for CPT 70558 is $161.09 for both facility and non-facility settings. This rate is based on 4.98 total RVUs multiplied by the 2025 conversion factor of $32.3465.

What is the difference between CPT 70558 and 70551?

CPT 70558 is an MRI brain with intravenous contrast material, while 70551 is without contrast. Code 70558 requires administration and documentation of gadolinium-based contrast agent and is used when contrast enhancement is medically necessary to evaluate lesions, tumors, or vascular structures.

Can you bill CPT 70558 and 70551 together?

No, you cannot bill both 70551 and 70558 together for the same session. If both non-contrast and contrast imaging are performed during the same encounter, you must bill CPT 70553 (MRI brain without contrast followed by with contrast), which includes both components.

How many RVUs is CPT code 70558 worth?

CPT 70558 has a total of 4.98 RVUs in 2025, consisting of 3.2 work RVUs, 1.63 practice expense RVUs, and 0.15 malpractice RVUs. The PE RVU is the same for both facility and non-facility settings.

What diagnosis codes support medical necessity for CPT 70558?

Common supporting diagnoses include brain neoplasms (C71.x, D33.x), multiple sclerosis (G35), seizures (R56.9, G40.x), headaches with red flags (R51.9), stroke evaluation (I63.x), metastatic disease (C79.31), and inflammatory conditions (G04.x). Prior authorization requirements vary by payer.

Do I need modifier 26 or TC when billing CPT 70558?

Use modifier 26 for professional component (physician interpretation only) or TC for technical component (facility/equipment only) when billing is split between separate entities. If one entity provides both the scan and interpretation, bill 70558 without modifiers for the global service.

What are the contrast contraindications that would prevent billing 70558?

Severe renal impairment (GFR <30) contraindicates gadolinium contrast due to nephrogenic systemic fibrosis risk. If contrast is contraindicated after preparation begins, do not bill 70558; instead bill 70551 (without contrast). Document the contraindication and clinical decision-making in the medical record.