1. MRI EXAM CPT CODE REFERENCE
Use this reference to quickly determine the correct exam for your patients based on the
indications described herein and the CPT for the order.
Please review the MRI safety checklist with each
patient. Notify WR Express Scheduling if your patient
For their comfort, IV sedation is available for your patients upon request. has a history of renal failure. Creatinine levels can be
obtained prior to contrasted studies, if needed, at WR
Garner, WR Chapel Hill or WR Cary. Call if you have
any questions 919-232-4700.
Procedure for CPT
Body Part Code
Indications for Exam or Study Contrast* SPEC
Pre-Authorization
Brain MRI Brain without contrast 70551 Alzheimer’s Stroke/CVA No Contrast
Mental status change TIA (transient ischemic attack)
Confusion Trauma
Neuro
Dementia Dizziness/Vertigo
Memory Loss Headaches
Suspected MS
MRI Brain with and without contrast 70553 Tumor/Mass/Cancer Pituitary lesion Yes Contrast
Cranial nerve lesions Acoustic neuroma
HIV/AIDS Syringomyelia (Syrinx)
Infection Visual change
Neuro
MS (Multiple Sclerosis) Metastases
Neurofibromatosis Vascular lesions (AVM)
Hearing loss, IAC mass Elevated prolactin
Bell’s Palsy (facial weakness)
MRA Brain: MRA Brain without contrast 70544 Aneurysm, family history No Contrast
Arterial Circulation TIA (transient ischemic attack) Neuro
Circle of Willis (COW) Stroke/CVA (cerebrovascular accident)
MRA Brain: MRA Brain without contrast 70544 Venous thrombosis No Contrast Neuro
Venous Circulation MRA Brain with and without contrast 70546 AVM Sinus thrombosis As determined
Neuro
Venous circulatory symptoms by radiologist
MRA NECK MRA Neck with and without contrast 70549 Bruit Yes Contrast
Stroke CVA (cerebrovascular accident)
Neuro
TIA (transient ischemic attack)
Abnormal doppler or dizziness
MRI Orbits MRI Brain with and without contrast 70553 Trauma Pseudotumor Yes Contrast
Includes brain plus Graves Disease Tumor/Mass/Cancer/Mets Neuro
cuts thru the orbits Exopthalmos/proptosis Vascular lesions (Hemangioma)
MRI Neck MRI Orbits/Face/Neck with and without 70543 Infection Tumor/Mass/Cancer/Mets Yes Contrast
Neuro
Soft Tissue contrast Pain Vocal Cord Paralysis
MRI SPINE: MRI Cervical Spine without contrast 72141 Neck pain Numbness No Contrast
Neuro
Cervical Arm/Shoulder pain Degenerative disk disease
Ortho
Disk herniation (HNP) Radiculopathy
MRI Cervical Spine with and without 72156 Syringomyelia (Syrinx) Myelopthy Yes Contrast
Neuro
contrast Discitis (disk infection) MS (Multiple Sclerosis)
Ortho
Osteomyelitis Tumor/Mass/Cancer/Mets
MRI SPINE: MRI Thoracic Spine without contrast 72146 Back Pain Trauma No Contrast
Thoracic Degenerative disk disease Compression fracture Neuro
Disk herniation (HNP) (No history of malignancy) Ortho
Radiculopathy
MRI Thoracic Spine with and without 72157 Syringomyelia (Syrinx) Myelopthy Yes Contrast
contrast Discitis (disk infection) MS (Multiple Sclerosis) Neuro
Osteomyelitis Tumor/Mass/Cancer/Mets Ortho
MRI SPINE: MRI Lumbar Spine without contrast 72148 Back/leg pain Sciatica/radiculopathy No Contrast
Lumbar Degenerative disk disease Spondylolisthesis
Disk herniation (HNP) Spinal stenosis Neuro
Radiculopathy Compression fracture Ortho
Trauma (No history of malignancy)
Scoliosis
MRI Lumbar Spine with and without 72158 Discitis (disk infection) Post-op Hx of back surgery Yes Contrast Neuro
contrast Osteomyelitis Tumor/Mass/Cancer/Mets Ortho
MRI Lumbosacral MRI Pelvis without contrast 72148 Leg Pain/sciatica Lumbar plexopathy No Contrast
Neuro
Plexus Radiculopathy Sacral/coccyx pain
MRI Brachial MRI Upper Extremity Non-joint with and 73220 Shoulder injury Brachial plexopathy Determined by
Neuro
Plexus without contrast Nerve avulsion Radiologist
MRI Chest: MRI Chest/Mediastinum with and without 71552 Tumor/Mass/Cancer/Mets Yes Contrast
Body
Mediastinum contrast
MRA Aorta MRA Aorta with and without contrast 74185 Abdominal aortic dissection Yes Contrast Body
MRA Aorta: With MRA Aorta with and without contrast MRA 74185 Peripheral vascular disease No Contrast
Body
peripheral runoff Lower Extremity with or without contrast 73725 Claudication
MRA Chest MRI Chest with and without contrast 71555 Excluding cardiac myocardium Yes Contrast
Body
Thoracic aorta
Breast MRI MRI Breast Bilateral with and without 77059 Newly diagnosed breast cancer Yes Contrast
contrast Family history of breast cancer
BRCA 1 or BRCA 2 genes (Some criteria may apply) Body
Implant integrity/Rupture
MRI Abdomen: MRI Abdomen with and without contrast 74183 Tumor/Mass/Cancer/Mets Yes Contrast
General Abdominal pain
MRI Abdomen: Post embolization Hepatitis
Liver Hemangioma Cirrhosis
Hepatoma Increased liver function tests Body
MRI abdomen: Hematuria (blood in urine)
Renal Renal mass (cyst or solid)
Transitional cell carcinoma of kidney
Abnormal findings
MRI abdomen: MRI Abdomen with and without contrast 74183 Adrenal mass or lesion Hypertension Determined by
Body
Adrenal Pheochromocytoma Radiologist
MRCP: Biliary MRI Abdomen with and without contrast 74183 Abdominal pain Jaundice Yes Contrast
Biliary obstruction Abnormal enzymes Body
Stones
MRCP: Pancreas MRI Abdomen with and without contrast 74183 Pancreatitis Increased liver function tests Yes Contrast
Pancreas mass Painless jaundice
Cholangiocarcinoma Ampulla evaluation Body
PSC (Primary Sclerosing Cholangitis)
MRA Abdomen MRA Abdomen with and without contrast 74185 Renal artery stenosis Mesenteric arterial Yes Contrast
Hypertension Ischemia Body
MRA Pelvis: MRA Pelvis with and without contrast 72198 Pelvic venous thrombosis Yes Contrast
Body
Iliac vessels
MRI Pelvis MRI Pelvis with and without contrast 72197 Pain Tumor/Mass/Cancer/Mets Yes Contrast
Soft Tissue: General Abscess Decubitus ulcer Body
MRI Pelvis MRI Pelvis with and without contrast 72197 Fibroid Pre/Post-Uterine Fibroid Embolization (UFE) Yes Contrast
Soft Tissue: Adenomyosis Endometrioma Body
Uterus/Ovaries Infertility Ovarian Mass
MR Dual Study: Crohn’s disease Crohn’s fistulous disease Yes Contrast
Enterography MRI Abdomen with and without contrast 74183 Celiac disease (Sprue) Small bowel tumor and glucagon Body
MRI Pelvis with and without contrast 72197
MRI Extremity, MRI Non-Joint without contrast: Fracture No Contrast
Non-Joint: Upper Extremity 73218 Stress fracture Body
Forearm Lower Extremity 73718 Muscle or tendon tear
Humerus
Lower Leg/Calf MRI Non-Joint with and without contrast: Abscess Myositis Yes Contrast
Femur/Thigh Upper Extremity 73220 Ulcer Osteomyelitis
Ortho
Lower Extremity 73720 Tumor/Mass/Mets Morton’s neuroma
Plantar fasciitis Soft tissue tumor or mass
MRI Extremity, MRI Joint without contrast: Arthritis Meninscal tear No Contrast
Joint: Upper Extremity 73221 Avascular necrosis (AVN) Muscle tear
Lower Extremity 73721 Stress fracture Ligament tear
Upper Internal derangement Cartilage tear Ortho
Hand Joint pain Ostochondritis dissecans
Wrist (OCD)
Elbow
Shoulder MRI Joint with and without contrast: Abscess Osteomyelitis Yes Contrast
SC Joint
Upper Extremity 73223 Ulcer Inflammatory arthritis
LOWER Lower Extremity 73723 Cellulitis Septic arthritis
Foot Plantar fasciitis Tumor/Mass/Mets Ortho
Ankle Myositis Labral tear
Knee
Hip (whole pelvis)
MRI Pelvis/Hip MRI Pelvis without contrast 72195 Fracture Trauma No Contrast
Hip/Pelvis Pain Muscle/Tendon tear Ortho
MRI Pelvis with and without contrast 72197 Tumor/Mass/Cancer/Mets Septic arthritis Yes Contrast
Ortho
Osteomyelitis
MRA Upper MRA Upper Extremity with and without 73225 Subclavian Tenderness Yes Contrast
Ortho
Extremity contrast Redness or swelling
MRA Lower MRA Lower Extremity with and without 73725 Peripheral vascular disease Yes Contrast
Ortho
Extremity contrast
MR Arthrogram MRI Upper Extremity Joint with and without 73222 Slap tear Ligament Injury Yes Contrast
Upper Extremity contrast Labral tear Tunnel syndrome
Shoulder Loose body Ortho
Elbow TFCC tear
Wrist
MR Arthrogram MRI Lower Extremity Joint with and without 73722 Labral tear Yes Contrast
Lower Extremity contrast FAI (Femoroacetabular impingement)
Hip Loose body Ortho
Knee OCD lesion (Osteochondritis Dissecans)
Ankle