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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 radiologistneuromra necKMRA Neck with and without contras
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 Mental status change TIA (transient ischemic attack) Confusion Trauma
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