| Short Descr | Mra w/o cont, pelvis | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 53 – Statute | MPI | A – Not applicable, as HCPCS priced under one methodology | Statute | 430 BIPA | ASC Payment Group Code | YY – 1/01/2008 | BETOS | I2D – Advanced imaging - MRI/MRA: other | TOS Code(s) | 4 – Diagnostic radiology | Added Date | 7/1/2003 | 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 |
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| 2003-07-01 | Added | Code added 7/1/2003 |
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