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Official Description

Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Magnetic resonance imaging (MRI) of the pelvis is a sophisticated imaging technique that provides detailed images of the pelvic region and its internal structures. This noninvasive procedure utilizes the magnetic properties of hydrogen nuclei found in the body, allowing for the visualization of soft tissues without the use of ionizing radiation. During the MRI process, a powerful magnetic field aligns the hydrogen atoms, and radio waves are transmitted to stimulate these atoms. The protons in various tissues emit specific radiofrequency signals that are captured by the MRI machine, which then processes these signals to create high-resolution, three-dimensional images of the pelvis. The patient is positioned on a motorized table that moves into a large MRI scanner, which houses the magnet. To enhance the quality of the images, small coils may be placed around the hip area to assist in the transmission and reception of radio waves. MRI of the pelvis is particularly useful for diagnosing a range of conditions, including injuries, trauma, congenital anomalies, and unexplained pain in the hip or pelvic region. The procedure can be performed without the use of contrast material, as seen in CPT® Code 72195, or with the administration of iodine-based contrast dye, as in CPT® Code 72196. CPT® Code 72197 specifically refers to the MRI procedure that is conducted first without contrast material, followed by the administration of contrast material for further imaging sequences. This dual approach allows physicians to obtain comprehensive information that may correlate with the patient's clinical signs and symptoms. In males, pelvic MRI can be instrumental in assessing conditions such as testicular lumps or swelling, as well as locating undescended testicles that may not be visible on ultrasound. For females, this imaging technique is valuable in evaluating issues such as abnormal vaginal bleeding, endometriosis, pelvic masses, or unexplained infertility.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

Magnetic resonance imaging (MRI) of the pelvis is indicated for a variety of clinical scenarios, particularly when detailed visualization of the pelvic structures is necessary. The following conditions and symptoms may warrant the use of this imaging technique:

  • Injury or Trauma MRI is often performed to assess damage to the pelvic region resulting from accidents or falls.
  • Congenital Anomalies The procedure can help identify birth defects or structural abnormalities within the pelvis.
  • Unexplained Hip or Pelvic Pain MRI is utilized to investigate persistent pain that does not have an obvious cause.
  • Testicular Lumps or Swelling In males, MRI can evaluate abnormalities in the testicular or scrotal area.
  • Undescended Testicle MRI may be used to locate a testicle that has not descended properly and is not visible on ultrasound.
  • Abnormal Vaginal Bleeding In females, MRI can assist in diagnosing the underlying causes of unusual bleeding.
  • Endometriosis The imaging technique is valuable for identifying endometrial tissue outside the uterus.
  • Pelvic Masses MRI can help characterize and assess the nature of masses found in the pelvic region.
  • Unexplained Infertility The procedure may be indicated to evaluate potential anatomical issues contributing to infertility.

2. Procedure

The MRI procedure for the pelvis involves several key steps to ensure accurate imaging and diagnosis. The following outlines the procedural steps as described:

  • Step 1: Patient Preparation The patient is informed about the procedure, including what to expect during the MRI. They may be asked to remove any metal objects, such as jewelry or clothing with metal fasteners, to prevent interference with the magnetic field. The patient is then positioned on a motorized table that will slide into the MRI scanner.
  • Step 2: Initial Imaging Without Contrast The MRI begins with the acquisition of images of the pelvis without the use of contrast material. This initial phase allows for the assessment of the pelvic structures and identification of any abnormalities that may be present.
  • Step 3: Administration of Contrast Material After the initial imaging, contrast material is administered intravenously. This contrast agent enhances the visibility of certain tissues and structures within the pelvis, providing clearer images for further evaluation.
  • Step 4: Further Imaging Sequences Following the administration of the contrast material, additional imaging sequences are performed. These sequences are designed to capture detailed images of the pelvic area, allowing for a comprehensive assessment of the structures and any potential pathologies.
  • Step 5: Image Review Once the imaging is complete, the images are reviewed by a radiologist or physician. They analyze the results to identify any abnormalities or conditions that correlate with the patient's clinical signs and symptoms.

3. Post-Procedure

After the MRI procedure, patients are typically monitored for a short period to ensure there are no immediate adverse reactions to the contrast material, if used. Most patients can resume their normal activities immediately following the procedure, as MRI is noninvasive and does not involve recovery time. The radiologist will prepare a report based on the images obtained, which will be sent to the referring physician for further discussion with the patient. It is important for patients to follow up with their healthcare provider to discuss the results and any necessary next steps based on the findings of the MRI.

Short Descr MRI PELVIS W/O & W/DYE
Medium Descr MRI PELVIS W/O & W/CONTRAST MATERIAL
Long Descr Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences
Status Code Active Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51) 4 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic imaging procedures apply...
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 88 -
APC Status Indicator Codes That May Be Paid Through a Composite APC
ASC Payment Indicator Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight.
Type of Service (TOS) 4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS) I2D - Advanced imaging - MRI/MRA: other
MUE 1
CCS Clinical Classification 198 - Magnetic resonance imaging

This is a primary code that can be used with these additional add-on codes.

0649T Add-on Code MPFS Status: Carrier Priced APC S Quantitative magnetic resonance for analysis of tissue composition (eg, fat, iron, water content), including multiparametric data acquisition, data preparation and transmission, interpretation and report, obtained with diagnostic MRI examination of the same anatomy (eg, organ, gland, tissue, target structure); single organ (List separately in addition to code for primary procedure)
0698T Add-on Code Resequenced Code MPFS Status: Carrier Priced APC S ASC Z2 Quantitative magnetic resonance for analysis of tissue composition (eg, fat, iron, water content), including multiparametric data acquisition, data preparation and transmission, interpretation and report, obtained with diagnostic MRI examination of the same anatomy (eg, organ, gland, tissue, target structure); multiple organs (List separately in addition to code for primary procedure)
26 Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
GC This service has been performed in part by a resident under the direction of a teaching physician
TC Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
MG The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional
MH Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider
ME The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
QQ Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
CR Catastrophe/disaster related
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
GA Waiver of liability statement issued as required by payer policy, individual case
MC Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues
MF The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59.
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
ET Emergency services
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
GZ Item or service expected to be denied as not reasonable and necessary
JZ Zero drug amount discarded/not administered to any patient
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
MA Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition
MB Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access
MD Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances
PD Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
PM Post mortem
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
Q5 Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
QJ Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b)
RT Right side (used to identify procedures performed on the right side of the body)
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XP Separate practitioner, a service that is distinct because it was performed by a different practitioner
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2001-01-01 Added First appearance in code book in 2001.
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