Billing and Coding: Automated Detection and Quantification of Brain Magnetic Resonance Imaging

Medicare will pay for primary brain MRI procedure codes 70551, 70552, and 70553 when billed appropriately, but the related add-on CPT codes 0865T and 0866T are explicitly not covered and are not eligible for additional payment. Claims must include valid ICD-10-CM diagnosis codes and required provider information (referring/ordering physician name and NPI when applicable), and non-covered services should be billed with the appropriate GA/GX/GY/GZ modifiers and ABN documentation per CMS guidance; Part A MACs have specific automatic denial and occurrence-code requirements for these modifiers.

"Primary brain MRI procedure codes 70551, 70552, and 70553 are eligible for Medicare payment when billed according to Medicare billing rules."

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