CPT Codes for MRI Safety—A User’s Guide

MR SAFETY CPT CODES

The MR safety CPT codes are designed to capture the work associated with specific tasks performed while planning for or performing an MR examination for a patient with an implant or foreign body, which is at high risk of interaction with the MR environment. Specific personnel perform and report these tasks, as described in Supplemental Data. CPT codes capture the work of MR technologists and medical physicists as clinical staff time, which is part of the technical component, while the physician’s work is assigned to the professional component.⁷ These codes are not meant to report the standard safety screening performed for all patients undergoing MR imaging, which is already included in each MR examination’s reimbursement. Similarly, these codes should not be used for all patients with implants or foreign bodies since not all patients will require the additional work. The MR safety CPT codes should only be used when a safety situation requires extra work by the MR safety team outside of the facility’s routine MR safety workflow, which includes MR conditional implants that may require precautions beyond normal operating mode of the MR system, implants lacking MR conditional labeling, or implants or foreign bodies that are typically contraindicated for MR.

The first 2 CPT codes in this family, 76014 and 76015, are used to report the MR safety assessment associated with an implant or foreign body, typically performed by an MR technologist. These 2 CPT codes are time-based and do not include any physician work. Code 76014 captures the first 15 minutes of work associated with the implant or foreign body assessment. As with all time-based CPT codes, this code can be reported when the midpoint (8 minutes) has passed. Code 76015 is used to report additional time after the initial 15 minutes, but the unit of time changes to 30 minutes. A minimum of 16 additional minutes of work is needed to report 76015 after the first 15 minutes captured with 76014. Code 76015 should not be reported without 76014, and 76015 can be reported up to 3 times for a given case as appropriate. Code 76015 would be expected to be used in scenarios requiring prolonged assessment time, such as with complex, multiple, or incompletely documented implants. These codes are typically used before the date of the MR examination; however, they can be used on the same day in urgent clinical situations. The MR technologist must document the relevant details of any implants and/or foreign bodies, along with the work/time in the medical record to report the codes.

CPT code 76016 is used to report an MR safety determination performed by a radiologist or other MR safety-trained QHP, typically performed before the day of the MRI examination. This code is expected to be reported infrequently, as it is only for clinical scenarios that require a risk-benefit analysis due to unclear MR conditions or when the examination may be contraindicated or limited by the presence of the implant or foreign body but important clinical information could be obtained from an MRI. Code 76016 is most likely performed by a radiologist but is not limited to radiologists. This code can be used on the same day as an MRI examination in urgent clinical scenarios. The code requires written documentation of the clinical scenario, risk-benefit analysis, potential alternate diagnostic tests, and recommendations to mitigate risk should the MR examination remain the chosen diagnostic test. A possible result of the work of 76016 is that the ordered MR examination is not recommended.

The safe performance of MRI in the presence of implants, foreign bodies, or other safety concerns may require work on the day of the MR examination in addition to the work typically associated with MR imaging. Codes 76017, 76018, and 76019 are designed for the additional work associated with these safety activities.

Code 76017 captures the work of customizing the MR protocol to address safety concerns identified during the MR safety assessment. The work is performed by a medical physicist and/or MR safety expert to comply with implant-related MR requirements while maintaining/optimizing diagnostic image quality. This code is not time-based. The work is done in collaboration with the supervising physician or QHP. The work must be documented in the medical record by the physician or QHP; best practice may be to have an independent physics report or cosigned report (by a medical physicist and physician).

Code 76018 is used to report work done by the MR team on the same day as the MRI to prepare implanted electronics for the MRI. Many devices require changing the device to “MRI mode” or programming specific settings per the manufacturer’s instructions. This code is not time-based. This code is separate from a cardiac device interrogation performed by cardiology or a neurostimulation analysis-programming service performed by neurology or neurosurgery and should be reported if the MR staff performs separate device programming. Modification of the settings of the device to minimize interactions between the device and MR environment is performed under the supervision of a qualified physician or QHP supervising the MR examination. Documentation of device modification by the physician or QHP overseeing the MR scan is required.

Code 76019 is used to report the work of positioning and/or immobilizing an implant before MR imaging. This can include the removal of a portion of the device or the immobilization of the device with a physical restraint. An example is the compression-wrapping of cochlear implants before an MRI per the manufacturer’s instructions. Immobilization or positioning of the implant is done on the day of the examination and performed under the supervision of a physician or other QHP. It is best practice to follow the manufacturer’s recommendations, including who the manufacturer suggests should position or immobilize the device. This code is not time-based. Documentation of the work is required by the supervising physician or QHP.