Contrast vs. No Contrast Reference Sheet Head/Neck

Scheduling: 717.291.1016 or 888.MRI.1377

Fax: 717.509.8642 ¡ñ Web Site:

Contrast vs. No Contrast Reference Sheet ¨C Head/Neck

Body Part

Reason for Exam

Procedure to Pre-Cert

CPT

Code

Brain

Alzheimer¡¯s/Confusion/Dementia

Headache/Migraine

Memory Loss

Mental Status Changes

Seizures

Stroke, CVA, TIA

Trauma

Cranial Nerve Lesions

F/U Lesion/Mass

IAC/Hearing Loss/Tinnitus/Vertigo

Infection

Metastatic Disease

Multiple Sclerosis

Neurofibromatosis

Pituitary

Fiducials

Gamma Knife Planning

Stroke/CVA/TIA

Aneurysm

Stroke/CVA/TIA

Stenosis > 60% on Doppler

Ultrasound

Venous Thrombosis

MRI Brain without Contrast

70551

MRI Brain without and with

Contrast

70553

MRI Brain with Contrast

70552

MRA Head without Contrast

70544

MRA Neck without Contrast

MRA Neck without and with

Contrast

MRV Head without and with

Contrast

MRI Orbits/Face/Neck without

and with Contrast

70547

70549

MRI Orbits/Face/Neck without

and with Contrast

70543

Brain

Brain

Circle of Willis

(COW)

Carotid

Carotid

Intracranial

Venous Sinus

Orbits

Neck-Soft Tissue

6/14

Optic Neuritis

Exophthalmos, Proptosis

Pseudotumor/Mass/Cancer/Mets

Vascular Lesions

Visual Disturbances

Infection

Tumor/Mass/Cancer/Mets

Vocal Cord Paralysis

70546

70543

Scheduling: 717.291.1016 or 888.MRI.1377

Fax: 717.509.8642 ¡ñ Web Site:

Contrast vs. No Contrast Reference Sheet ¨C Spine

Body Part

Reason for Exam

Procedure to Pre-Cert

CPT

Code

Spine: Cervical

Degenerative Disease

Disc Herniation

Extremity Pain/Weakness

Neck Pain

Radiculopathy

Trauma

Discitis

Mass/Lesion

Osteomylitis

Back Pain

Compression Fx

Disc Herniation

Radiculopathy

Trauma

Discitis

Mass/Lesion

Osteomylitis

Back Pain

Compression Fx

Disc Herniation

Radiculopathy

Stenosis

Trauma

Discitis

Mass/Lesion

Osteomylitis

Post Lumbar Surgery ( ................
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