CPT Code 76390 MR spectroscopy Appendix A.2 OUTPATIENT IMAGING Effective January 1, 2015 All outpatient imaging services on this list require pre-certification Description 70551 70552 70553 70554 70555 Magnetic resonance imaging, brain (including brain stem) without contrast material Magnetic resonance imaging, brain (including brain stem) MRI Brain without contrast matierial, followed by contrast material and further sequences MRI, Brain, functional MRI including rest selection and administration of repetitive body part movement and /or visual stimulation, requiring physician or psychologist adminstration Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing 71550 71551 71552 71555 75557 75559 75561 75563 75565 MRI chest w/o dye MRI chest w/dye MRI chest w/o dye & w/dye MRI angio chest w/ or w/o dye Cardiac MRI w/ morph Cardiac MRI w/ stress img Cardiac MRI for morph w/dye Card MRI w/ stress img & dye Card MRI veloc flow mapping 72141 72142 72146 72147 72148 72149 72156 72157 72158 72159 Magnetic resonance imaging, spinal canal and contents, cervical; without contrast material Magnetic resonance imaging, apinal canal and contents, thoracic; without contrast material (s) Magnetic resonance imaging, spinal canal and contents, lumbar, without contrast material Magnetic resonance imagaing, spinal canal and contents, without contrast material, followed by contrast material and further sequesnces; cervical Magnetic resonance imagaing, spinal canal and contents, without contrast material, followed by contrast material and further sequesnces; Thoracic Magnetic resonance imagaing, spinal canal and contents, without contrast material, followed by contrast material and further sequesnces; Lumbar MRI angiography, spinal canal and contents, with or without contrast material Current Procedural Terminology (CPT ) is a copyright of American Medical Association 2011. All rights reserved. CPT is a registered trademark of the
73218 73219 73220 73221 73222 73223 73225 73718 73719 73720 73721 73722 73723 73725 77084 72195 72196 72197 72198 MRI, upper extremity, other than joint, without contrast material MRI upper extremity w/o & w/dye Magnetic resonance imaging, any joint of upper extremity; without contrast materials without contrast material, followed by contrast material and further sections MR angio ur extr w/o & w/dye MRI, lower extremity other than joint;without contrast material without contrast material, followed by contrast material and further sequences Magnetic resonance imaging; any joint of lower extremity; without contrat material without contrast material, followed by contrast material and further sections MRI, lower extremity, with or without contrast material Magnetic image bone marrow MRI, pelvis, without contrast material without contrast material, followed by contrast material and further sections MRI angiography, pelvis, with or without contrast material 70557 70558 70559 70336 70540 70542 70543 70544 70545 70546 70547 70548 70549 74181 74182 74183 74185 76498 77021 77058 77059 77022 78205 78206 Magnetic Resonance Imaging (including brain stem and skull base), during open intracranial procedure; without contrast material Magnetic Resonance Imaging (including brain stem and skull base), during open intracranial procedure; with contrast material Magnetic Resonance Imaging (including brain stem and skull base), during open intracranial procedure; without contrast material, followed by contrast material & further sequences Magnetic Image jaw joint MRI orbit/face/neck w/o dye MRI orbit/face/neck w/dye MRI orbit/face/neck w/o & w/dye MR angiography head w/o dye MR angiogrphy head w/dye MR angiography head w/o dye & w/dye MR angiograhy neck w/o dye MR angiography neck w/dye MR angiography neck w/o & w/ dye MRI abdomen w/o dye MRI abdomen w/ dye MRI abdomen w/o & w/dye MRI angio abdom w/ or w/o dye MRI procedure MR guidance for needle place MRI, breast without and/or, unilateral MRI, breast without and/or, bilateral Magnetic Resonance guidance for, and monitoring of, parenchymal tissue ablation Liver imaging (SPECT) Liver imaging (SPECT); with vascular flow Current Procedural Terminology (CPT ) is a copyright of American Medical Association 2011. All rights reserved. CPT is a registered trademark of the
78710 Kidney imaging morphology; tomographic (SPECT) 78451 78452 78459 78466 78468 78469 78491 78492 78494 78453 78454 HT muscle image spect sing HT muscle image spect mult Heart muscle imaging (PET) Heart infarct image Heart infarct image (EF) Heart infarct image (3D) Heart image (PET) image single Heart image (PET) image multiple Heart image spect Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, add'l quantification, when performed); single study, at rest or stress (exercise or pharmacologic) Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, add'l quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection 78607 78608 78609 78630 78071 78072 Brain imaging; tomographic (SPECT) PET, brain, metabolic evaluation PET, brain, perfusion evaluation CParathyroid b i planar l fl id imaging fl i (including i ( t isubtraction, l di i t when d ti performed); f t iwith l) ttomographic (SPECT) (SPECT) Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization 78320 Bone and/or joint imaging; tomographic (SPECT) 78816 PET image w/ CT full body 78803 78807 78811 78812 78813 78814 78815 Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent; tomographic (SPECT) Radiopharmaceutical localization of inflammatory process; tomographic (SPECT) PET, limited area (eg. Chest, head, neck) PET, Skull base to mid-thigh PET, whole body PET image w/ct Lmtd PET image w/ct skull-thigh 76376 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation 76377 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation Current Procedural Terminology (CPT ) is a copyright of American Medical Association 2011. All rights reserved. CPT is a registered trademark of the
Current Procedural Terminology (CPT ) is a copyright of American Medical Association 2011. All rights reserved. CPT is a registered trademark of the
Current Procedural Terminology (CPT ) is a copyright of American Medical Association 2011. All rights reserved. CPT is a registered trademark of the
Current Procedural Terminology (CPT ) is a copyright of American Medical Association 2011. All rights reserved. CPT is a registered trademark of the