CMS Pub. 100-04, ch. 13, § 40.1.2

Providers must report HCPCS codes when submitting claims for MRA of the chest, abdomen, head,

neck or peripheral vessels of lower extremities. The following HCPCS codes should be used to report

these services:

MRA Code

MRA of head 70544, 70544-26, 70544-TC

MRA of head 70545, 70545-26, 70545-TC

MRA of head 70546, 70546-26, 70546-TC

MRA of neck 70547, 70547-26, 70547-TC

MRA of neck 70548, 70548-26, 70548-TC

MRA of neck 70549, 70549-26, 70549-TC

MRA of chest 71555, 71555-26, 71555-TC

MRA of pelvis 72198, 72198-26, 72198-TC

MRA of abdomen (dates of service on or

after July 1, 2003) – see below.

74185, 74185-26, 74185-TC

MRA of peripheral vessels of lower

extremities

73725, 73725-26, 73725-TC

Hospitals subject to OPPS should report the following C codes in place of the above HCPCS codes as

follows:

• MRA of chest 71555: C8909 – C8911

• MRA of abdomen 74185: C8900 – C8902

• MRA of peripheral vessels of lower extremities 73725: C8912 – C8914

For claims with dates of service on or after July 1, 2003, coverage under this benefit has been expanded

for the use of MRA for diagnosing pathology in the renal or aortoiliac arteries. The following HCPCS

code should be used to report this expanded coverage of MRA:

• MRA, pelvis, with or without contrast material(s) 72198, 72198-26, 72198-TC

Hospitals subject to OPPS report the following C codes in place of HCPCS code 72198:

• MRA, pelvis, with or without contrast material(s) 72198: C8918 - C8920

NOTE: Information regarding the claim form locator that corresponds to the HCPCS code and a table

to crosswalk its CMS-1450 form locator to the 837 transaction is found in Chapter 25.

40.1.3 - Special Billing Instructions for RHCs and FQHCs

(Rev. 3227, Issued: 04-02-15, Effective; ASC-X12: January 1, 2012 Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors: June 11,

2013, ICD-10: Upon Implementation of ICD-10

Implementation: ASC X12: November 10, 2014 Fluorodeoxyglucose (FDG) Positron Emission

Tomography (PET) for Solid Tumors: May 19, 2014 - MAC Non-Shared System Edits; July 7,

2014 - CWF development/testing, FISS requirement development; October 6, 2014 - CWF, FISS,

MCS Shared System Edits), ICD-10: Upon Implementation of ICD-10)

Independent RHCs and free-standing FQHCs bill under bill type 71X and 73X for the professional

component utilizing revenue codes 520 and 521 as appropriate. HCPCS coding is not required. The

technical component is outside the scope of the RHC/FQHC benefit. The provider of the technical

service bills using the ASC X12 837 professional claim format or on Form CMS-1500.

The technical component for a provider based RHC/FQHC is typically furnished by the provider. The

provider of that service bills under bill type 13X or 85X as appropriate using its outpatient provider

number (not the RHC/FQHC provider number since these services are not covered as RHC/FQHC

services). Effective 4/1/06, type of bill 14X is for non-patient laboratory specimens and is no longer

applicable for radiology services.

40.1.4 – Payment Requirements

(Rev. 3227, Issued: 04-02-15, Effective; ASC-X12: January 1, 2012 Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors: June 11,

2013, ICD-10: Upon Implementation of ICD-10

Implementation: ASC X12: November 10, 2014 Fluorodeoxyglucose (FDG) Positron Emission

Tomography (PET) for Solid Tumors: May 19, 2014 - MAC Non-Shared System Edits; July 7,

2014 - CWF development/testing, FISS requirement development; October 6, 2014 - CWF, FISS,

MCS Shared System Edits), ICD-10: Upon Implementation of ICD-10)

For claims with dates of service on and after February 24, 2011, the following diagnosis code and

modifier shall be reported on MRI claims for beneficiaries with implanted PMs, that are outside FDA-approved labeling for use in an MRI environment (in a Medicare-approved clinical study):

• Appropriate MRI code

• Q0 modifier

• Condition code 30 (for institutional claims)

• If ICD-9-CM is applicable

o ICD-9 code V70.7- Examination of participant in clinical trial (for institutional claims)

o ICD-9 code V45.02 (automatic implantable cardiac defibrillator) or

o ICD-9 code V45.01 (cardiac pacemaker)

• If ICD-10-CM is applicable

• Z00.6 - Encounter for examination for normal comparison and control in clinical research

program

• Z95.810 - Presence of automatic (implantable) cardiac defibrillator or

• Z95.0 - Presence of cardiac pacemaker

For claims with dates of services on and after July 7, 2011, the following codes shall be reported on MRI

claims for beneficiaries with implanted PMs that have FDA-approved labeling for use in an MRI

environment:

• Appropriate MRI code

• KX modifier

• If ICD-9-CM is applicable

o ICD-9 code V45.01 (cardiac pacemaker)

• If ICD-10-CM is applicable

o ICD-10 code Z95.0 (cardiac pacemaker)

Payment is as follows:

• Professional claims (practitioners and suppliers) - based on the Medicare Physician Fee

Schedule (MPFS)

• Inpatient (11x) - Prospective payment system (PPS), based on the diagnosis-related group

• Hospital outpatient departments (13x) - Outpatient PPS, based on the ambulatory payment

classification

• Rural Health Clinics/Federally Qualified Health Centers (RHCs/FQHCs) (71x/77x) - All-inclusive rate, professional component only, based on the visit furnished to the RHC/FQHC

beneficiary to receive the MRI. The technical component is outside the scope of the RHC/FQHC

benefit. Therefore the provider of the technical service bills their A/B MAC (B) on the ASC X12

837 professional claim format or hardcopy Form CMS-1500 and payment is made under the

MPFS.

• Critical access hospitals (CAHs) (85x) –

o For CAHs that elected the optional method of payment for outpatient services, the

payment for technical services would be the same as the CAHs that did not elect the

optional method - Reasonable cost.

o The A/B MAC (A) pays the professional component at 115% of the MPFS.

Deductible and coinsurance apply.