Friday, May 20, 2016

Guideline for billing MRA procedure PROCEDURE CODE 70544, 70545, 70547, 70549

 Magnetic Resonance Angiography (MRA)

 Magnetic Resonance Angiography (MRA) Coverage Summary

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.
HCPCS Coding Requirements

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

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