CPT Codes
Summary of fMRI CPT Code Approval Process
The CPT code process for fMRI began in early 2004 and was a coordinated effort of many professional societies such as: ASNR, ASFNR, ACR, and the AAN. The ASNR and ASFNR Clinical Practice Committee; CPT Coding and Reimbursement Subcommittee coordinated the fMRI CPT code process. Three national committee’s are needed to approve their component of the CPT process. The committees include:
AMA CPT Editorial Panel
A multi-specialty panel which deals with coding and nomenclature issues. Its main charge is to maintain the Current Procedural Terminology (CPT) manual. This includes approving new codes, editing existing codes to reflect current practice, creating modifiers etc. The CPT Editorial Panel approved level I CPT codes for fMRI at its October 2005 meeting in Seattle.
RVU Update Committee (RUC)
The RUC is a panel consisting of physician members from multiple specialties, overseen by the AMA. The RUC reviews each newly approved procedure code and assigns RVUs (relative value units) for practice expense as well as physician work involved in the new procedure. After surveys were performed the specialty societies presented recommendations for values to the RUC at the February 2006 meeting in Miami the RUC approved negotiated values.
The Centers for Medicare and Medicaid Services (CMS)
CMS reviews the new codes and the RUC recommended values and decides whether to change them. In November 2006 CMS issued a notice in the Federal Register which listed fMRI as payable codes with values, as approved by the RUC. Currently the codes are officially published with the values assigned by the RUC and the codes are assigned a ‘payable’ status by CMS
A Summary of the CPT Descriptors and Values are as Follows:
70554
Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration (Approved at 2.11 RVUs for physician work and a total of 2.81 RVUs for professional payment, 13.71 RVUs for technical payment adding up to 16.52 RVUs when billed globally) 70554 is not to be reported in conjunction with 96020 or 70555
70555
Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing (Approved at 2.54 RVUs for physician work for a total of 3.37 RVUs) 70555 can only be reported when 96020 is performed.
96020
Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or psychologist, with review of test results and report. (Approved at 3.43 RVUs for physician work for a total of 4.46 RVUs.) Do not report 70554 & 70555 in conjunction with 70551-53 unless a separate diagnostic MRI is performed.