CMS Pub. 100-04, ch. 13, § 40.1.1

Section 1861(s)(2)(C) of the Social Security Act provides for coverage of diagnostic testing. Coverage

of magnetic resonance angiography (MRA) of the head and neck, and MRA of the peripheral vessels of

the lower extremities is limited as described in Publication (Pub.) 100-03, the Medicare National

Coverage Determinations (NCD) Manual. This instruction has been revised as of July 1, 2003, based on

a determination that coverage is reasonable and necessary in additional circumstances. Under that

instruction, MRA is generally covered only to the extent that it is used as a substitute for contrast

angiography, except to the extent that there are documented circumstances consistent with that

instruction that demonstrates the medical necessity of both tests. Prior to June 3, 2010, there was no

coverage of MRA outside of the indications and circumstances described in that instruction.

Effective for claims with dates of service on or after June 3, 2010, contractors have the discretion to

cover or not cover all indications of MRA (and magnetic resonance imaging (MRI)) that are not

specifically nationally covered or nationally non-covered as stated in section 220.2 of the NCD Manual.

Because the status codes for HCPCS codes 71555, 71555-TC, 71555-26, 74185, 74185-TC, and 74185-

26 were changed in the Medicare Physician Fee Schedule Database from ‘N’ to ‘R’ on April 1, 1998,

any MRA claims with those HCPCS codes with dates of service between April 1, 1998, and June 30,

1999, are to be processed according to the contractor’s discretionary authority to determine payment in

the absence of national policy.

Effective for claims with dates of service on or after February 24, 201l, Medicare will provide coverage

for MRIs for beneficiaries with implanted cardiac pacemakers or implantable cardioverter defibrillators

if the beneficiary is enrolled in an approved clinical study under the Coverage with Study Participation

form of Coverage with Evidence Development that meets specific criteria per Pub. 100-03, the NCD

Manual, chapter 1, section 220.2.C.1.