CPT 70559Radiology

Mri brain w/o & w/dye

CPT code 70559 covers an MRI scan of the brain performed twice: first without contrast dye, then with contrast dye injected to highlight blood vessels and abnormal tissue. This dual-phase imaging helps doctors identify tumors, strokes, infections, and other brain abnormalities more clearly than a single scan.

Showing rates for

National Average

Base Medicare rate

$152.68

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)

1.24

MP RVU

0.28

Total RVU

4.72

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

NCCI bundling edits

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Billing tips

Document medical necessity for both pre- and post-contrast sequences explicitly in the ordering physician's documentation
Impact: Prevents denials for lack of medical necessity which account for 30-40% of MRI claim denials and protects the full $152.68 reimbursement
Verify contrast administration is documented in both technologist notes and radiologist report with type, dose, and route specified
Impact: Missing contrast documentation may trigger downcoding to 70553 (without contrast only), reducing reimbursement by approximately $30-40
Code 70559 separately from other brain MRI codes performed same day - do not use 70551 or 70553 in combination with 70559
Impact: Prevents unbundling denials and ensures correct single code submission for dual-contrast protocol at full allowed amount
For split-component billing, ensure facility bills TC and radiologist bills 26 on same date of service with matching diagnosis codes
Impact: Mismatched components or dates can delay payment or trigger audits, potentially holding $152.68 in reimbursement for 30-90 days
Append modifier 59 when billing 70559 with cervical or thoracic spine MRI on same date if separate clinical indications exist
Impact: Supports payment for both procedures rather than bundling denial, preserving full reimbursement for each study
Submit with ICD-10 codes that specifically justify dual-phase imaging such as neoplasm evaluation, demyelinating disease, or vascular malformation assessment
Impact: Generic headache or dizziness codes may trigger prior authorization denials or medical review delaying payment

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Frequently asked questions

What is the difference between CPT codes 70551, 70553, and 70559 for brain MRI?

CPT 70551 is brain MRI without contrast only, 70553 is brain MRI with contrast only, and 70559 is brain MRI performed both without and with contrast in the same session. Code 70559 requires documentation of both pre-contrast and post-contrast image sequences and reimburses at $152.68 for the complete dual-phase protocol.

How much does Medicare pay for CPT code 70559 in 2025?

The 2025 Medicare national average payment rate for CPT 70559 is $152.68 for both facility and non-facility settings. This represents the total allowed amount for the global service including both technical and professional components with 4.72 total RVUs.

Can you bill CPT 70559 with modifier 26 for professional component only?

Yes, radiologists in split-billing arrangements should append modifier 26 to CPT 70559 when billing only for the interpretation and report while the facility bills the technical component with modifier TC. The professional and technical components must be billed separately with the same date of service and diagnosis codes.

Does CPT 70559 require prior authorization from insurance?

Most commercial payers and Medicare Advantage plans require prior authorization for CPT 70559 due to its advanced imaging classification and use of contrast material. Traditional Medicare does not require prior authorization but may conduct post-payment medical necessity reviews. Always verify payer-specific requirements before scheduling.

What diagnosis codes support medical necessity for CPT 70559?

Common supporting diagnoses include brain neoplasms (C71.x, D33.x), metastatic disease (C79.31), multiple sclerosis (G35), seizure disorders (G40.x), cerebrovascular disease (I67.x), encephalitis/meningitis (G04.x, G03.x), and abnormal findings on prior imaging (R90.x). Generic symptoms like headache (R51) often require additional clinical justification.

How many RVUs is CPT code 70559 worth in 2025?

CPT 70559 has 4.72 total RVUs in 2025, consisting of 3.2 work RVUs, 1.24 practice expense RVUs, and 0.28 malpractice RVUs. These values are the same for both facility and non-facility settings based on the CMS Physician Fee Schedule RVU25A.

Can you bill CPT 70559 and 70540 together for brain and orbit MRI?

Yes, CPT 70559 (brain with and without contrast) and 70540 (orbit with and without contrast) can be billed together when separate clinical indications exist for each anatomic area, but modifier 59 may be required on one code to indicate distinct procedural services and prevent bundling denials from the payer.