CPT code 70553 is one of the highest-dollar, highest-volume MRI codes. Approximately 2 million scans are processed through Medicare, commercial plans, and self-pay every year. Yet roughly 238,000 of those claims get bounced on the first pass just because of the wrong modifier placement. There are mostly eight modifiers that are usually placed with CPT 70553, and mastering their placement is necessary in order to protect your revenue. This guide helps you master the placement of these modifiers so you can protect revenue, speed cash-flow, and keep your practice audit-ready.
CPT code 70553 designates a two-part brain MRI in which the patient is scanned first without and then with intravenous contrast in one session. The code covers all scanner time, contrast materials, and the radiologist’s interpretation, giving clinicians a baseline anatomical series plus an enhanced vascular view for spotting tumors, strokes, demyelination, or post-surgical change.
Pricing (CY 2025, U.S.):
Actual reimbursement and patient responsibility swing with payer contracts, site of service, and component billing (global vs. -TC/-26 split), but CPT 70553 remains one of imaging’s higher-revenue, higher-denial codes, making precise modifier use critical.
| Modifier | Purpose | When to Use It |
|---|---|---|
| -26 | Professional component only | Radiologist reading images from another facility |
| -TC | Technical component only | The imaging center owns equipment |
| -59 | Distinct service | Separate MRI in the same session |
| -76 | Repeat procedure, same provider | Same-day re-scan by the same radiologist |
| -77 | Repeat procedure, different provider | Same-day re-scan by another radiologist |
| -52 | Reduced services | No contrast used |
| -53 | Discontinued procedure | Claustrophobia, allergic reaction, tech failure |
| MA–MH | AUC compliance | Medicare advanced imaging rules |
Brain MRI with and without contrast (CPT code 70553) is a high-value exam, and a high-denial one. Payers watch the claim line like a hawk, ready to bounce it the moment a modifier is missing or misplaced. Below is a plain-language rundown of every modifier that can make or break your 70553 reimbursement:
What is it?
26 flags that you’re billing only the physician’s interpretation and report, not the cost of running the magnet.
How to use it?
Attach -26 when a radiologist reads images produced by someone else’s equipment, typical for hospital-based practices and teleradiology groups. Your claim should carry the radiologist’s NPI, place-of-service 22 (hospital), and only the professional RVUs.
Why precision matters.
If you forget -26, Medicare sees two full (global) 70553 charges, one from the hospital and one from you. The duplicate triggers an automatic denial or, worse, an overpayment demand months later.
TC says you’re billing only the technical portion: scanner time, technologist labor, contrast, supplies, and facility overhead.
Hospitals and imaging centers append -TC when they want payment for the equipment piece, while the radiology group bills the read with -26. One claim, one modifier, never both from the same billing NPI.
CMS’s edits reject any claim line that carries both -TC and -26. A missing -TC can also underpay you by hundreds of dollars because the payer assumes the professional fee alone.
The “unbundling” modifier that tells the payer a second, separate imaging study honestly deserves payment.
Use -59 (or a payer-preferred X modifier) only when 70553 is clinically distinct from another head-or-neck MRI performed in the same session, different indication, different anatomic focus, or different timing.
National Correct Coding Initiative (NCCI) edits bundle same-session imaging into one payment. -59 is your escape hatch, but apply it without solid chart proof and you invite denials, audits, and accusations of unbundling fraud.
76 tells the payer that the same physician repeated the same MRI on the same day.
Apply when motion artifact, equipment hiccups, or new neuro symptoms force you to redo the study, and the very same radiologist reads it again.
Without -76 the claim looks like an accidental duplicate and will be denied outright. Write a one-line addendum in the report: “Repeat imaging due to excessive patient motion during initial series.
Like -76, but a different radiologist interpreted the repeat scan.
Attach when staffing changes mid-shift or an on-call neuroradiologist re-images a patient a few hours later.
Duplicate denials plague repeat imaging. -77 flags the legitimate hand-off and directs payment to the correct reader.
Signals that part of the standard service was intentionally skipped, for instance, when contrast was contraindicated.
Bill 70553-52 if you performed only the non-contrast portion, but still used the longer 70553 scanner slots and protocol. Some practices instead switch to 70551 (MRI brain w/o contrast); follow payer policy and document why contrast was withheld.
Billing the complete code with no modifier in a reduced study is overpayment territory. Many commercial plans automatically down-price claims with -52, but they’ll deny or claw back if you omit it.
Marks a started-but-aborted scan, think severe claustrophobia, adverse reaction, or sudden equipment failure.
Attach -53 when the exam stops early and cannot be completed that day. Document table time, sequences obtained, and the reason for stoppage.
Payers will partially reimburse when they see -53 plus supporting notes. Skip it, and they’ll either demand the full image set (which doesn’t exist) or deny the claim entirely.
A suite of G-codes (MA through MH) that tell Medicare whether the ordering provider complied with the Appropriate Use Criteria program for advanced imaging.
For now, most MACs accept informational AUC modifiers without denying payment. When CMS enters the penalty phase, missing or wrong AUC modifiers will mean automatic non-payment for MRIs ordered in outpatient and ASC settings.
Getting ahead of AUC compliance today avoids a cash cliff tomorrow. Build AUC fields into your order entry and teach schedulers which MA–MH code applies.
CPT code 70553 earns premium reimbursement, but dollars evaporate the moment a modifier misfires. Hard-code 26–TC logic in your scrubber, reserve 59 for truly distinct studies, and treat 52/53 like partial-payment tickets, not afterthoughts. Master these essentials now, and your next brain-MRI claim will glide through the clearinghouse instead of landing in denial purgatory.
By outsourcing your billing services to us, you can expect revenue growth of up to 20%
By outsourcing your billing services to us, you can expect revenue growth of up to 20%
The most common modifier mistakes are dangling modifiers and misplaced modifiers. Both terms refer to modifiers that are connected to the wrong thing in a sentence.
Step 1: Identify the modifier. In most cases, dangling modifiers are placed at the start of a sentence, though they can also be found at the end. Step 2: Identify the noun or pronoun next to the modifying clause in the sentence. Step 3: Check to see if the modifier and the noun or pronoun go together logically.
CPT modifiers are added to the end of a CPT code with a hyphen. In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second.
CPT® 70551 is an MRI of the brain (including brain stem) without contrast.
Cpt 70551 description: Non-contrast magnetic resonance imaging of the brain is used to evaluate conditions like stroke, tumor, headache, seizures, demyelinating disease, or trauma.
Quick billing notes (brief):
