Reimbursement
$410.82
Threshold
N/A
2026 Status
Active
What is CPT Code 70553?
CPT 70553 is defined as: Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences. This protocol is the standard for detailed evaluation of tumors, multiple sclerosis, or complex neurological conditions.
This code is primarily used for Specialist services. It falls under the category of Diagnostic Radiology / MRI and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
2.6
Physician Effort
PE (Non-Fac)
9.5
Practice Expense
Malpractice
0.2
Risk Factor
Total RVU
12.3
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
technical suppression
Efficiency adjustment reduces the Technical Component (TC) value, reflecting faster scan times of modern 3T magnets.
auc compliance
Appropriate Use Criteria mechanisms continue to be emphasized to ensure medical necessity for high-cost imaging.
packaging rules
Contrast materials are bundled into the OPPS payment for hospital settings but remain carve-outs for physician offices.
Administrative Framework
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
minimum time
Procedure-based
staff type
Radiologist, MRI Technologist
frequency
Based on clinical necessity for monitoring or diagnosis.
add on codes
contrast material
The supply of contrast (e.g., Gadolinium, HCPCS A9579) is separately billable in office settings (POS 11) but bundled in Hospital contexts.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
Common Clinical Scenarios
CMS Eligibility: Requirement for high-resolution intracranial assessment.. N/A.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 70551
70551 is without contrast only.
VS 70552
70552 is with contrast only (less common for brain).
Frequently Asked Questions
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