CPT codes 70553 plays a vital role in neurology billing, where accuracy and strict adherence to coding rules are essential. Neurology is a complex medical specialty, and even small billing mistakes in neurological diagnostic tests can lead to claim denials, delayed reimbursements, or audits. Imaging studies of the brain require precise coding because they directly impact how insurers evaluate and process claims. When documentation, modifiers, or coding details are incorrect, medical practices risk revenue loss and compliance issues.
Magnetic Resonance Imaging (MRI) is one of the most important diagnostic tools used in neurology to assess disorders of the brain and central nervous system. MRI scans help neurologists make informed clinical decisions, especially when advanced imaging with and without contrast is required. CPT codes 70553 is commonly used for MRI studies of the brain and brainstem performed with and without contrast. While its clinical value is well recognized, billing it correctly can be challenging. This guide helps physicians, billers, and administrative staff understand proper usage, documentation requirements, and billing rules to stay compliant and maintain steady cash flow.
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CPT Codes 70553 – Description
CPT codes 70553 falls under Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck and is maintained by the American Medical Association (AMA).
This code is used when a physician performs an MRI of the brain, including the brainstem, first without contrast and then with contrast during the same visit. The MRI allows for a detailed evaluation of brain structures and related abnormalities.
CPT 70553 represents a comprehensive imaging service. It should only be reported when both non-contrast and contrast-enhanced MRI studies are completed in a single session.
Key Points to Remember
- Includes both non-contrast and contrast-enhanced imaging
- Covers the brain and brainstem
- Contrast administration must be clearly documented
- CPT codes 70551 and 70552 must not be billed separately when performed together
When CPT Codes 70553 Is Used
CPT codes 70553 is used when a physician requires detailed imaging of the brain and brainstem to evaluate neurological symptoms that cannot be fully assessed using non-contrast imaging alone.
Contrast-enhanced imaging improves visualization of:
- Tumors and metastases
- Inflammatory or infectious processes
- Demyelinating diseases
- Vascular abnormalities
- Cranial nerve pathologies
Because of its diagnostic value, CPT 70553 is commonly ordered by neurologists, neurosurgeons, oncologists, and emergency physicians.
Common Clinical Scenarios Where CPT Codes 70553 Applies
1. Vertigo and Ataxia Evaluation
A patient presents with worsening dizziness, balance issues, and coordination problems. Neurological examination reveals nystagmus and ataxia. To investigate the cause, the neurologist orders an MRI of the brain and brainstem with and without contrast.
- Non-contrast images help rule out acute stroke or hemorrhage
- Contrast images assist in identifying tumors or inflammatory lesions
CPT code 70553 accurately represents this complete diagnostic study.
2. New-Onset Seizures
A patient experiences new-onset generalized seizures. Between episodes, the neurological examination appears normal. To identify possible structural abnormalities, the physician orders MRI imaging with and without contrast.
This imaging approach helps detect:
- Brain tumors
- Cortical dysplasia
- Post-traumatic lesions
- Infections or inflammation
When both imaging phases are completed, CPT 70553 is the correct code to report.
3. Progressive Cranial Nerve Deficits
A patient presents with gradually worsening facial weakness, double vision, or hearing loss. The physician suspects involvement of the brainstem or cranial nerves.
- Non-contrast imaging identifies gross anatomical changes
- Contrast imaging highlights tumors, neuromas, meningiomas, or inflammatory conditions
MRI with and without contrast provides critical diagnostic clarity in these cases.
Applicable Modifiers for CPT Codes 70553
Correct modifier usage is essential for accurate reimbursement. The following modifiers are commonly used with CPT 70553.
Modifier TC – Technical Component
Used by hospitals or imaging facilities billing for:
- MRI equipment
- Supplies
- Technologist services
This modifier indicates that the facility provided the technical portion of the service but did not interpret the images.
Modifier 26 – Professional Component
Used by physicians who:
- Interpret MRI images
- Prepare and sign the report
- Do not own the imaging equipment
Modifier 26 ensures reimbursement for interpretation services only.
Modifier 59 – Distinct Procedural Service
Modifier 59 is appended when CPT 70553 is performed with other procedures on the same day and must be recognized as a separate service. This helps prevent bundling-related denials.
Modifier 76 – Repeat Procedure by Same Physician
Append modifier 76 when the same physician repeats CPT 70553 on the same day due to medical necessity.
Modifier 77 – Repeat Procedure by Different Physician
Use modifier 77 when another physician repeats CPT 70553 on the same date of service.
Billing and Reimbursement Guidelines for CPT Codes 70553
Report CPT 70553 Correctly
When both non-contrast and contrast-enhanced MRI studies are performed during the same session, CPT 70553 should always be reported.
Do not bill separately:
- CPT 70551 (MRI without contrast)
- CPT 70552 (MRI with contrast)
Billing these codes separately can result in denials and compliance issues.
Use Modifiers Appropriately
Modifiers such as TC and 26 must accurately reflect whether the billing is for technical, professional, or global services. Incorrect modifier usage is a common cause of underpayment and claim rejection.
Ensure Medical Necessity
Medical necessity must be clearly documented. Payers closely review MRI claims, particularly when contrast is used or when imaging is repeated.
Documentation Requirements
Complete and accurate documentation is critical for compliance and reimbursement. Medical records should include:
- Patient name
- Date of service
- Clinical indication and symptoms
- Relevant medical history
- Confirmation of non-contrast and contrast imaging
- Type and amount of contrast administered
- Signed physician interpretation report
Incomplete documentation increases audit risk and delays payment.
Common Billing Mistakes to Avoid
- Billing CPT 70551 and 70552 separately
- Missing or incorrect modifiers
- Lack of contrast documentation
- Insufficient medical necessity justification
- Unsigned or incomplete reports
Avoiding these errors improves first-pass claim acceptance and cash flow.
FAQs
- Can CPT 70553 be billed without contrast documentation?
No. Contrast administration must be clearly documented to support billing CPT 70553. - Can CPT 70553 be billed globally?
Yes. If the same entity provides both technical and professional components, the global service may be billed without modifiers. - Is prior authorization required for CPT 70553?
In most cases, yes. Many commercial payers and Medicare Advantage plans require prior authorization. - Can CPT 70553 be repeated on the same day?
Yes, but only with documented medical necessity and appropriate modifiers (76 or 77).
Final Summary
CPT codes 70553 is used for MRI studies of the brain and brainstem performed with and without contrast during the same session. Accurate coding, proper modifier usage, complete documentation, and clear medical necessity are essential for timely reimbursement and compliance.
Neurology billing and imaging services are complex, and many practices struggle to manage claims in-house. Partnering with an experienced medical billing company such as MedBillingRes can help reduce denials, improve cash flow, and ensure compliance. With specialty-focused neurology billing, certified coders, and advanced automation, MedBilling Res allows providers to focus on patient care while the revenue cycle is managed efficiently.
