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Body PartProcedure for Pre-authorizationcPt codeindications for exam or studycontrast*sPecBrain mriMRI Brain without contrast70551 Alzheimer s Stroke/CVAM ental status change TIA (transient ischemic attack)Confusion TraumaDementia Dizziness/VertigoMemory Loss HeadachesSuspected MSNo ContrastneuroMRI Brain with and without contrast70553 Tumor/Mass/Cancer Pituitary lesionCranial nerve lesions Acoustic neuromaHIV/AIDS Syringomyelia (Syrinx)Infection Visual changeMS (Multiple Sclerosis) MetastasesNeurofibromatosis Vascular lesions (AVM)Hearing loss, IAC mass Elevated prolactinBell s Palsy (facial weakness)Yes Contrastneuromra Brain: Arterial CirculationCircle of Willis (COW)MRA Brain without contrast70544 Aneurysm, family historyTIA (transient ischemic attack)Stroke/CVA (cerebrovascular accident)No Contrastneuromra Brain: Venous CirculationMRA Brain without contrast70544 Venous thrombosisNo ContrastneuroMRA Brain with and without contrast70546 AVM Sinus thrombosisVenous circulatory symptomsAs determined by radiologist
Body Part Procedure for Pre-authorization cPt code indications for exam or study contrast* Pec Brain mri MRI Brain without contrast 70551 Alzheimer’s Stroke/CVA
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