Does 70557 require prior authorization?

No, 70557 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 70557?

Medicare facility rate: $18.35. Non-facility rate: $18.35. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

$18.35

Non-Facility

$18.35

Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.
Providers should check and apply Correct Coding Initiative (CCI) edits and applicable LCD guidance for correct code combinations before billing.

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
G71.21 | Nemaline myopathy
G83.0 | Diplegia of upper limbs
H44.19 | Other endophthalmitis
H44.532 | Leucocoria, left eye

A57204 — Billing and Coding: MRI and CT Scans of the Head and Neck

L37373 — MRI and CT Scans of the Head and Neck

A57215 — Billing and Coding: MRI and CT Scans of the Head and Neck

L35175 — MRI and CT Scans of the Head and Neck

Ask Verity about documentation requirements, denial risks, or coverage in your state.