MRI CPT Coding Guide MRA Head & Brain 70544 Angiography, Head; w/o contrast 70545 Angiography, Head; w contrast 70546 Angiography, Head; w & w/o contrast 70547 Angiography, Neck; w/o contrast 70548 Angiography, Neck; w contrast 70549 Angiography, Neck; w & w/o contrast   MRI Brain 70551 Brain w/o contrast 70552 Brain w contrast 70553 Brain w & w/o contrast   MRI Orbit & Face 70540 Orbit, Face & Neck, Carotids(pituitary, IAC’s) w/o contrast 70542 Orbit, Face w constrast 70543 Orbit, Face w & w/o contrast 70336 TMJ (UNI or BILAT)   Chest 71555 Angiography, Chest 71550 Chest w/o contrast 71551 Chest w contrast 71552 Chest w & w/o contrast   Cardiac 75557 Cardiac MRI for Morphology and Function w/o contrast 75559 Cardiac MRI Morphology and Function w/o contrast with Stress Imaging 75561 Cardiac MRI for Morphology and Function w & w/o contrast 75563 Cardiac MRI Morphology and Function w & w/o contrast with Stress Imaging 75565 Cardiac MRI for Velocity Flow 78451 Myocardial Perfusion Imaging/CT (SPECT), Single Study, at Rest or Stress 78452 Myocardial Perfusion Imaging/CT (SPECT), Multiple Study, at Rest and/or Stress 78453 Myocardial Perfusion Imaging, Single Study, at Rest or Stress 78454 Myocardial Perfusion Imaging, Multiple Study, at Rest and/or Stress   Abdomen 74185 Angiography Abdomen 74181 Abdomen w/o contrast 74182 Abdomen w contrast 74183 Abdomen w & w/o contrast   Pelvic 72198 Angiography Pelvic 72195 Pelvis w/o contrast 72196 Pelvis w contrast 72197 Pelvis w/o contrast   Supply 77084 MRI Bone Marrow Blood Sample Upper Extremity 73225 MRA Upper extremity 73221 Upper extremity, joint (shoulder, elbow, wrist, hand) w/o contrast 73222 Upper extremity joint (shoulder, elbow, wrist) w contrast 73223 Upper extremity joint w & w/o contrast 73218 Upper extremity, other than joint (hummerus) w/o contrast 73219 Upper extremity, other than joint w contrast 73220 Upper extremity, other than joint w & w/o contrast   Lower Extremity 73725 Angiography, Lower Extremity 73718 Lower Extremity, other than joint (thigh, lower leg, foot) w & w/o contrast 73719 Lower Extremity other than joint w contrast 73720 Lower Extremity other than joint w & w/o contrast 73721 Lower Extremity, joint w/o contrast 73722 Lower Extremity joint w contrast 73723 Lower Extremity, joint w & w/o contrast   Cervical Spine 72141 Cervical w/o contrast 72142 Cervical w contrast 72156 Cervical w & w/o contrast   Lumbar Spine 72148 Lumbar w/o contrast 72149 Lumbar w contrast 72158 Lumbar w & w/o contrast   Thoracic Spine 72146 Thoracic Spine w/o contrast 72147 Thoracic Spine w contrast 72157 Thoracic Spine w & w/o contrast   Breast 77021 VAC Breast Biopsy 77059 Bilateral Breast Imaging 77058 Unilateral Breast Imaging   Cash Procedure (non covered benefit) 76498 Unlisted Screening Procedure 76390 MRI Spectroscopy Patient Name Phone D.O.B. Diagnosis / Symptoms Desired Appointment Time & Date Allergic To Iodine DM CKD Known Arrhythmia Pacemaker Asthma Known Allergies     For Contrast Studies:     Creatinine BUN Date Referring Physician Full Name (in lieu of signature) Copies Sent to Date   Phone Fax Email

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Westside Medical Associates of Los Angeles

Copyright ©2012 Westside Medical Imaging
64-Slice CT Scan, Body, Heart, and Vascular Imaging in Southern California
99 N La Cienega Blvd. • Suite 103 • Beverly Hills, CA • 310.623.1150

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