CPT 75559Radiology

Cardiac mri w/stress img

CPT code 75559 covers cardiac magnetic resonance imaging (MRI) performed with pharmacological stress, a non-invasive test that creates detailed images of the heart while simulating the effects of exercise to detect coronary artery disease and other cardiac conditions.

Showing rates for

National Average

Base Medicare rate

$363.90

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

2.95

PE RVU (NF)

8.19

MP RVU

0.11

Total RVU

11.25

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

NCCI bundling edits

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Billing tips

Verify prior authorization before scheduling - most commercial payers require pre-authorization for cardiac MRI with stress, which can take 3-5 business days
Impact: Prevents denials averaging $363.90 per case; prior auth denial rate for cardiac MRI exceeds 15% without proper verification
Document stress agent type, dose, administration time, and hemodynamic response throughout the procedure in the medical record
Impact: Critical for audit defense; missing stress documentation accounts for 25% of post-payment recoupments
Bill global code only when practice owns MRI equipment and provides both professional and technical services; use modifier 26 for hospital-based readings
Impact: Incorrect component billing results in overpayment recovery or underpayment of approximately $150-200 per case
Confirm contraindications to stress agents are documented if procedure is performed with alternative protocol or discontinued
Impact: Supports use of modifier 52 or 53 and prevents wholesale denial; incomplete documentation reduces payment by 50-100%
Do not separately bill cardiac MRI without contrast (75557) or with contrast (75561) on the same date of service as 75559
Impact: Creates unbundling denial with 100% payment recoupment; NCCI edits bundle these services
Include physician supervision documentation showing presence during stress agent administration and immediate availability for emergencies
Impact: Medicare requirement for pharmacological stress; absence of documentation can trigger denial of entire $363.90 claim

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 75559 in 2025?

The 2025 Medicare national average reimbursement for CPT 75559 is $363.90 for both facility and non-facility settings. This rate is based on 11.25 total RVUs (2.95 work RVU, 8.19 practice expense RVU, and 0.11 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Does CPT 75559 include contrast administration?

CPT 75559 is a comprehensive code that may include contrast when clinically necessary for the stress imaging protocol, but contrast administration is not specifically required by the code definition. The code primarily describes the pharmacological stress component combined with cardiac MRI. Always document whether contrast was used and the clinical rationale.

Can you bill CPT 75559 with modifier 26 for professional component only?

Yes, modifier 26 should be appended when the physician provides only the professional component (interpretation and report) but does not own the MRI equipment. This is common in hospital settings where radiologists or cardiologists read studies performed on hospital-owned equipment, resulting in payment for approximately 40-50% of the total allowed amount.

What is the difference between CPT 75559 and 75563?

CPT 75559 covers cardiac MRI with pharmacological stress imaging using drugs like adenosine or dobutamine to simulate exercise stress. CPT 75563 is not a valid code for cardiac stress MRI. The cardiac MRI family includes 75557 (without contrast), 75561 (with contrast), and 75559 (with stress). Each code represents a distinct imaging protocol.

How many RVUs is CPT code 75559 worth in 2025?

CPT code 75559 has 11.25 total RVUs in 2025, consisting of 2.95 work RVUs, 8.19 practice expense RVUs (both facility and non-facility), and 0.11 malpractice RVUs according to the CMS Medicare Physician Fee Schedule released December 23, 2024.

Does CPT 75559 require prior authorization from Medicare or commercial insurance?

Traditional Medicare does not require prior authorization for CPT 75559, though some Medicare Advantage plans do require it. Most commercial payers require prior authorization for cardiac MRI with stress due to the high cost and availability of alternative testing. Always verify payer-specific requirements before scheduling to avoid denials.

What diagnosis codes support medical necessity for CPT 75559?

Common supporting ICD-10 codes include I25.10 (atherosclerotic heart disease), I20.9 (angina pectoris), I25.5 (ischemic cardiomyopathy), I42.0-I42.9 (cardiomyopathy), R07.9 (chest pain), and Z95.1 (coronary artery bypass graft status). Documentation must demonstrate why pharmacological stress MRI is necessary rather than standard stress testing or other imaging modalities.