70553

MRI Brain Without and With Contrast

CPT code 70553 describes a comprehensive magnetic resonance imaging (MRI) of the brain, including the brainstem, performed first without contrast material, followed by the administration of intravenous contrast material and additional imaging sequences. This diagnostic procedure utilizes a powerful magnetic field and radiofrequency pulses to produce detailed cross-sectional images of the brain's internal structures, including the cerebrum, cerebellum, ventricles, and cranial nerves. The initial 'without contrast' phase provides a baseline assessment of anatomy, detecting structural abnormalities, hemorrhages, or large masses. The subsequent 'with contrast' phase, typically involving the injection of a gadolinium-based contrast agent (GBCA), is crucial for highlighting areas of blood-brain barrier breakdown, inflammation, or hypervascularity. This dual-phase approach is the gold standard for evaluating complex neurological conditions such as primary or metastatic intracranial neoplasms, multiple sclerosis (where contrast helps distinguish between active and chronic demyelinating plaques), infectious processes like abscesses or meningitis, and vascular malformations. The procedure allows for high-resolution visualization of soft tissues that are often poorly seen on computed tomography (CT) scans. By comparing pre-contrast and post-contrast images, radiologists can characterize the nature of a lesion, assess its margins, and determine its relationship to surrounding neurovascular structures. The total examination time is longer than a standard non-contrast MRI, typically ranging from 45 to 60 minutes, and requires the patient to remain perfectly still to ensure image clarity and diagnostic accuracy.

Clinical Indications

  • Suspected or known primary or metastatic brain tumors
  • Evaluation of active vs. chronic demyelinating lesions in Multiple Sclerosis (MS)
  • Intracranial infectious processes such as meningitis, encephalitis, or abscess
  • Evaluation of pituitary gland disorders or adenomas
  • Assessment of suspected vascular malformations or vasculitis
  • Pre-surgical planning for intracranial lesions
  • Follow-up imaging for patients with a history of brain surgery or radiation therapy
  • Evaluation of cranial nerve palsies or suspected acoustic neuroma
  • Seizure disorders with suspected focal structural causes
  • Chronic or atypical headaches with red-flag symptoms

Procedure Steps

  1. Patient screening for metallic implants, pacemakers, or claustrophobia
  2. Positioning the patient supine on the MRI table with the head secured in a specialized head coil
  3. Acquisition of initial localizer/scout sequences to align the imaging planes
  4. Performance of pre-contrast sequences including T1-weighted, T2-weighted, and FLAIR (Fluid-Attenuated Inversion Recovery) imaging
  5. Performance of Diffusion-Weighted Imaging (DWI) to assess for acute ischemia or cellularity
  6. Intravenous administration of a gadolinium-based contrast agent by a nurse or technologist
  7. Acquisition of post-contrast T1-weighted sequences in multiple planes (axial, sagittal, coronal)
  8. Optional acquisition of specialized sequences such as perfusion imaging or MR spectroscopy if clinically indicated
  9. Review of images for quality control and completeness before the patient leaves the suite
  10. Post-processing of data on a workstation for interpretation by a radiologist

Coding Guidelines

  • Do not report 70553 in conjunction with 70551 (MRI brain without contrast) or 70552 (MRI brain with contrast) for the same imaging session.
  • The code 70553 represents the combined service; it is not appropriate to unbundle the pre- and post-contrast phases.
  • If only the professional component is performed, append modifier 26. If only the technical component is performed, append modifier TC.
  • Administration of contrast is included in the procedural description and should not be billed separately via a CPT code, although the contrast supply (HCPCS Q-code) may be billable in some settings.
  • For MR angiography of the head, use codes 70544-70546 instead of or in addition to 70553 if specifically ordered and performed.

Associated ICD-10 Codes