| Short Descr | Mra w/o fol w/cont, abd | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 53 – Statute | MPI | A – Not applicable, as HCPCS priced under one methodology | Statute | 1833(t)(2) | ASC Payment Group Code | YY – 1/01/2008 | BETOS | I2D – Advanced imaging - MRI/MRA: other | TOS Code(s) | 4 – Diagnostic radiology | Added Date | 10/1/2001 | 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. | MUE | 1 | MUE | Not applicable/unspecified. | OTS Orthotic | No | CCS Clinical Classification | 198 - Magnetic resonance imaging |
| 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 | 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 | 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 |
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| 2001-10-01 | Added | Code added 10/1/2001 |
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