Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 ● Web Site: www.MRIGroup.com Contrast vs. No Contrast Reference Sheet – Head/Neck Body Part Reason for Exam Procedure to Pre-Cert CPT Code Brain Alzheimer’s/Confusion/Dementia MRI Brain without Contrast 70551 Headache/Migraine Memory Loss Mental Status Changes Seizures Stroke, CVA, TIA Trauma Brain Cranial Nerve Lesions MRI Brain without and with 70553 F/U Lesion/Mass Contrast IAC/Hearing Loss/Tinnitus/Vertigo Infection Metastatic Disease Multiple Sclerosis Neurofibromatosis Pituitary Brain Fiducials MRI Brain with Contrast 70552 Gamma Knife Planning Circle of Willis Stroke/CVA/TIA MRA Head without Contrast 70544 (COW) Aneurysm Carotid Stroke/CVA/TIA MRA Neck without Contrast 70547 Carotid Stenosis > 60% on Doppler MRA Neck without and with 70549 Ultrasound Contrast Intracranial Venous Thrombosis MRV Head without and with 70546 Venous Sinus Contrast Orbits Optic Neuritis MRI Orbits/Face/Neck without 70543 Exophthalmos, Proptosis and with Contrast Pseudotumor/Mass/Cancer/Mets Vascular Lesions Visual Disturbances Neck-Soft Tissue Infection MRI Orbits/Face/Neck without 70543 Tumor/Mass/Cancer/Mets and with Contrast Vocal Cord Paralysis 6/14 Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 ● Web Site: www.MRIGroup.com Contrast vs. No Contrast Reference Sheet – Spine Body Part Reason for Exam Procedure to Pre-Cert CPT Code Spine: Cervical Degenerative Disease MRI Cervical Spine without Contrast 72141 Disc Herniation Extremity Pain/Weakness Neck Pain Radiculopathy Trauma Spine: Cervical Discitis MRI Cervical Spine without and with 72156 Mass/Lesion Contrast Osteomylitis Spine: Thoracic Back Pain MRI Thoracic Spine without Contrast 72146 Compression Fx Disc Herniation Radiculopathy Trauma Spine: Thoracic Discitis MRI Thoracic Spine without and with 72157 Mass/Lesion Contrast Osteomylitis Spine: Lumbar Back Pain MRI Lumbar Spine without Contrast 72148 Compression Fx Disc Herniation Radiculopathy Stenosis Trauma Spine: Lumbar Discitis MRI Lumbar Spine without and with 72158 Mass/Lesion Contrast Osteomylitis Post Lumbar Surgery (<10 yrs) 6/14 Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 ● Web Site: www.MRIGroup.com Contrast vs. No Contrast Reference Sheet – MSK Body Part Reason for Exam Procedure to Pre-Cert CPT Code Extremity, Non Fracture/Stress Fracture MRI Non-Joint without Contrast Joint: Muscle/Tendon Tear Upper Extremity 73218 Forearm Lower Extremity 73718 Hand/Finger Humerus Foot/Toes Lower Leg Thigh Extremity, Non (Venous Injection) MRI Non-Joint without and with Contrast Joint: Abscess Upper Extremity 73220 Forearm Cellulitis Lower Extremity 73720 Hand/Finger Morton’s Neuroma Humerus Osteomylitis Foot/Toes Soft Tissue Tumor/Mass Lower Leg Ulcer Thigh Extremity, Joint: Arthritis MRI Joint without Contrast Elbow Cartilage Tear Upper Extremity 73221 Shoulder Fracture/Stress Fracture Lower Extremity 73721 Wrist Internal Derangement Ankle Joint Pain Hip Ligament Tear Knee Meniscal Tear Muscle/Tendon Tear Extremity, Joint: (Venous Injection) MRI Joint without and with Contrast Elbow Abscess Upper Extremity 73223 Shoulder Cellulitis Lower Extremity 73723 Wrist Osteomylitis Ankle Tumor/Mass Hip Ulcer Knee Joint: Arthrogram Intra-articular Injection MRI Joint with Contrast Upper Extremity 73222 Lower Extremity 73722 Pelvis - MSK Muscle/Tendon Tear MRI Pelvis without Contrast 72195 Pelvic Pain Sacrum/ Coccyx SI Joints Pelvis – MSK Abscess/Ulcer MRI Pelvis without and with Contrast 72197 Osteomylitis Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 ● Web Site: www.MRIGroup.com Contrast vs. No Contrast Reference Sheet – Body Body Part Reason for Exam Procedure to Pre-Cert CPT Code Abdomen MRCP MRI Abdomen without Contrast 74181 Adrenals Abdomen Kidneys MRI Abdomen without and with Contrast 74183 Liver Mass MRE Abdomen – MRA Renal Arteries MRA Abdomen without and with Contrast 74185 Mesenteric Ischemia Brachial Plexus Brachial Plexus Neuropathy MRI Chest without Contrast 71550 Chest – MRA Thoracic Aorta MRA Chest without and with Contrast 71555 Vascular Anomalies Subclavian Vessels Chest Mediastinum Hilar/mediastinal adenopathy MRI Chest without Contrast 71550 AC Joint Pain SC Joint Pain Scapula Sternum Chest Mediastinum Infection MRI Chest without and with Contrast 71552 Mass Metastatic Disease Pelvis - Female Adenomyosis MRI Pelvis without Contrast 72195 Endometriomas Menses Problems Pelvic Pain Uterine Anomalies Pelvis - Female Adnexal Mass MRI Pelvis without and with Contrast 72197 Endometrial CA Known Fibroids Ovarian CA Ovarian Cysts Pre-embolization work-up Uterine Artery Embolus 6/14 .