What this is, in plain language
A detailed magnetic resonance scan of the brain performed both before and after IV contrast to highlight blood vessels, tumors, infections, or areas of inflammation.
Why a clinician orders it
Severe headaches with red flags, neurological symptoms, suspected tumors, MS, stroke follow-up, or unexplained changes in cognition or vision.
Medical necessity — what insurers usually look at
Commonly requires prior authorization in outpatient settings via a radiology benefit manager. Insurers may want a recent neurological exam and the clinical question the scan is meant to answer.
Documentation to ask about
- ✓Neurological exam findings
- ✓Onset and pattern of symptoms
- ✓Prior imaging results, if any
- ✓Reason contrast is being used
Questions for your provider
- ?Is prior authorization in progress?
- ?Are there any reasons I should not receive contrast?
Why this code is in our seed set
Highest-volume brain MRI code; included in the CMS Top 200 Ranked by Services and the most common MRI managed by radiology benefit managers.
Validated against
- •CMS Top 200 Level I CPT Codes Ranked by Services
- •ACR Appropriateness Criteria, Headache and Neurologic Imaging
- •AMA CPT code 70553 descriptor
Terms you'll see
The insurer is reviewing whether the service is clinically appropriate for your situation.
Some services may need plan approval before they are performed.