70551
MRI brain, without contrast
Magnetic resonance imaging of the brain without contrast material. CMS 2026 global wRVU 1.48, total RVU approximately 7.41, Medicare global allowable approximately $247. The workhorse outpatient brain MRI for non-acute neurologic complaints.
When to use it
Use 70551 for non-acute brain MRI when contrast is not required. Common indications: subacute or chronic headache evaluation, seizure work-up, neurodegenerative disease characterization (dementia, MS), trigeminal neuralgia, sensorineural hearing loss screening, pituitary microadenoma screening, white matter disease assessment.
Full guidance
70552 (with contrast) is required for tumor characterization, infection (encephalitis, meningitis), MS activity, post-treatment surveillance. 70553 (without and with) is the standard for MS protocol, tumor characterization, and most oncology surveillance.
Documentation checklist
- ✓Order with indication. "Brain MRI" without indication is denied; pair with a clinical reason.
- ✓Verify MRI safety: implanted devices (pacemaker, ICD, neurostimulator), metallic foreign body history, prior aneurysm clipping, claustrophobia accommodation needs.
- ✓Interpretation report covers cerebrum, cerebellum, brainstem, ventricular system, cisterns, cranial nerves visible, sella, calvarium, and any incidental findings. Comparison to prior imaging.
- ✓If MS, neurodegenerative, or oncologic, document relevant disease-specific findings (T2/FLAIR lesion burden, enhancement, atrophy patterns).
- ✓Setting modifier; radiologist signature and date.
Common pitfalls
- !Billing 70551 for an acute stroke or hemorrhage workup. Acute stroke is typically CT (70450) first; brain MRI without contrast is for subacute and chronic neurologic complaints.
- !Performing 70551 on a patient with a non-MRI-conditional cardiac device. MRI safety screen is a structural deliverable; missing it is both a billing and patient-safety failure.
- !Billing 70551 plus 70552 separately when both phases were obtained. The combined code is 70553.
- !Reading a brain MR angiogram (MRA head) and billing 70551. MRA head is 70544 / 70545 / 70546 (depending on contrast phase), not 70551.
- !Missing comparison to prior imaging in the report when a prior MRI is available. Insurance audits for serial comparison documentation.
Payer notes
Medicare covers 70551 with appropriate indication. Outpatient prior authorization is common for commercial payers. Document the indication clearly — "chronic headache" alone may not pass auth; pair with red flags (new pattern, fever, neuro deficit, age over 50, etc.). MS and oncology surveillance studies typically pass auth more easily than non-specific headache work-up.