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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