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MRI/MRA Categories:
Head/Brain
Cervical Spine
Thoracic Spine
Lumbosacral Spine
Orbits, Face or Neck
Tempomandibular Joints (TMJ)
Abdomen
Lower Extremity Joint
(Hip, Knee, Ankle)
Lower Extremity Non Joint
Upper Extremity Joint
(Shoulder, Elbow, Wrist)
Upper Extremity Non Joint
Chest
Pelvis/SI Joints
Breast
MRA/MRV
Other Misc Codes
Helpful Links
MRI Health History Screening Form
Outpatient MRI Order Form
Breast MRI Order Form
Prep Reference Guide
MRI Pre-Authorization Guide
(Femur, Lower Leg, Foot)
(Humerus, Forearm, Hand)
Page | 1
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Summary of Contents for McLaren MRI
- Page 1 Upper Extremity Non Joint (Humerus, Forearm, Hand) Chest Pelvis/SI Joints Breast MRA/MRV Other Misc Codes Helpful Links MRI Health History Screening Form Outpatient MRI Order Form Breast MRI Order Form Prep Reference Guide Page | 1...
- Page 2 1. 70551 - MRI Brain without contrast 2. 70552 - MRI Brain with contrast 3. 70553 - MRI Brain with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 3 1. 72141 - MRI Cervical Spine without contrast 2. 72142 - MRI Cervical Spine with contrast 3. 72156 - MRI Cervical Spine with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 4 1. 72146 - MRI Thoracic Spine without contrast 2. 72147 - MRI Thoracic Spine with contrast 3. 72157 - MRI Thoracic Spine with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 5 1. 72148 - MRI Lumbosacral Spine without contrast 2. 72149 - MRI Lumbosacral Spine with contrast 3. 72158 - MRI Lumbosacral Spine with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 6 1. 70540 - MRI Face Neck Orbit without contrast 2. 70542 - MRI Face Neck Orbit with contrast 3. 70543 - MRI Face Neck Orbit with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 7 1. 74181 - MRI Abdomen without contrast 2. 74182 - MRI Abdomen with contrast 3. 74183 - MRI Abdomen with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 8 1. 72195 - MRI Pelvis without contrast 2. 72196 - MRI Pelvis with contrast 3. 72197 - MRI Pelvis with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 9 1. 71550 - MRI Chest without contrast 2. 71551 - MRI Chest with contrast 3. 71552 - MRI Chest with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 10 1. 73221 - MRI Upper Extremity Joint without contrast 2. 73222 - MRI Upper Extremity Joint with contrast 3. 73223 - MRI Upper Extremity Joint with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 11 1. 73218 - MRI Upper Extremity without contrast 2. 73219 - MRI Upper Extremity with contrast 3. 73220 - MRI Upper Extremity with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 12 1. 73718 - MRI Lower Extremity without contrast 2. 73719 - MRI Lower Extremity with contrast 3. 73720 - MRI Lower Extremity with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 13 1. 73721 - MRI Lower Extremity Joint without contrast 2. 73722 - MRI Lower Extremity Joint with contrast 3. 73723 - MRI Lower Extremity Joint with and without contrast Note: Due to differing scan protocols or other possible contraindications to contrast at the time of exam, if possible, we ask that all three codes be pre-authorized.
- Page 14 MRI Pre-Authorization Guide MRI Breast 1. 77058 - MRI Breast Unilateral 1. 77059 - MRI Breast Bilateral Note: These codes cover any variation of contrast or non-contrast imaging. Back to top Page | 14...
- Page 15 MRI Temporomandibular Joint(s) (TMJ) 1. 70336 - MRI TMJ without contrast 2. 70336 - MRI TMJ with contrast 3. 70336 - MRI TMJ with and without contrast Note: This code covers any variation of contrast or non-contrast imaging. Back to top...
- Page 16 MRI Pre-Authorization Guide MRA/MRV Magnetic Resonance Angiography (MRA), optimized for arterial structures. Magnetic Resonance Venography (MRV), optimized for venous structures. MRV will bill using the same codes as MRA. 1. 74185, 73725 MRA Abdomen Pelvis with Bilateral Lower Extremities (Runoff) 2.
- Page 17 70551 - MRI Stroke Protocol 159T - CAD for Breast MRI 19085 - MRI Breast Biopsy or Localization 19086 - MRI Breast Biopsy or Localization Additional Lesions If you have any questions or comments, please email mnmpacs@mclaren.org Back to top...
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