Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth	
	MassHealth
	Freestanding Magnetic Resonance				Imaging Center Bulletin 10
	May 2004

	TO:	Freestanding Magnetic Resonance Imaging Centers Participating in MassHealth

	FROM:	Beth Waldman, Medicaid Director 

	RE:	Revised List of Service Codes and Descriptions (2004 HCPCS)

Background	The Division of Health Care Finance and Policy has adopted rates for freestanding magnetic resonance imaging (FMRI) centers.  The rates for the new codes introduced under the 2004 HCPCS code book are effective for dates of service on or after April 30, 2004.

	MassHealth will pay freestanding magnetic resonance imaging (MRI) centers only for the service codes listed in this bulletin.  Services must be provided in accordance with standards developed by the American College of Radiology (ACR).  MassHealth will review claims to identify whether the services were provided for the recommended clinical condition based on the ACR appropriateness criteria.

Billing Information	As stated in FMRI Center Bulletin 9, providers may no longer bill for the global fee method of payment when the provider has furnished both the professional and technical components of a service.  FMRI centers providing both the professional and technical components of a service must bill for these components separately to receive the equivalent of the global payment.  

To bill for the professional component, the provider must append modifier 26 to the appropriate service code.  To bill the technical component, the provider must report the same service code on a second claim line, and append modifier TC.  Services that have professional and technical components must be billed with a modifier.  Any claims for such services that are not billed with modifier 26 or TC will be denied with error code 135, “modifier required.”  On the HIPAA-compliant 835 remittance advice transaction, this denial will be reflected as an adjustment reason code 04 and remarks code M78.
	
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Billing Information 		Please Note:  FMRI centers may bill for either the professional and 
(cont.)			technical component of a service or procedure when both services are performed or for the technical component only.  FMRI centers may not bill for the professional component only when performed as a single service. 

MassHealth will not pay FMRI centers separately for paramagnetic contrast material (e.g., gadolinium).  Payment for paramagnetic contrast material is considered bundled into the payment for the MRI or MRA service.

Prior 				MassHealth requires the physician ordering the MRI to obtain prior
Authorization (P.A.)	authorization for those services designated “P.A.” in the service 
descriptions of this bulletin.  No payment will be made for these services unless prior authorization has been obtained from MassHealth before the delivery of services.  MassHealth will not grant retroactive 
prior-authorization requests.  A prior authorization determines only the medical necessity of the authorized service and does not establish or waive any other prerequisites for payment such as, but not limited to, member eligibility or the availability of other health-insurance payment.  To request prior authorization, physicians must follow the billing instructions in Subchapter 5 of the Physician Manual (Section 512).

Service Codes 	FMRI centers may bill for either the technical component only of the
for Freestanding	following MRI/MRA scans, or both technical and professional
MRI Centers	components, when applicable.

	Service
	Code	Service Description 

	70336	Magnetic resonance (e.g., proton) imaging,
			temporomandibular joint(s) (P.A.)
	70540	Magnetic resonance (e.g., proton) imaging, orbit, face, and 
			neck; without contrast material(s)
	70542		with contrast material(s)
		
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Service Codes	Service
for Freestanding	Code	Service Description 
MRI Centers
(cont.)	70543		without contrast material(s), followed by contrast material(s) and further sequences
		70544	Magnetic resonance angiography, head; without contrast 
				material(s)
	70545		with contrast material(s)
	70546		without contrast material(s), followed by contrast 
			material(s) and further sequences
	70547	Magnetic resonance angiography, neck; without contrast 
			material(s)
	70548		with contrast material(s)
	70549		without contrast material(s), followed by contrast 
			material(s) and further sequences
70551	Magnetic resonance (e.g., proton) imaging, brain (including 
			brain stem); without contrast material
	70552		with contrast material(s)
	70553		without contrast material, followed by contrast
			material(s) and further sequences	
71550	Magnetic resonance (e.g., proton) imaging, chest (e.g., for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s)
	71551	with contrast material(s)
	71555	Magnetic resonance angiography, chest (excluding 
			myocardium), with or without contrast material(s) 
	72141	Magnetic resonance (e.g., proton) imaging, spinal canal 
			and contents, cervical; without contrast material
	72142		with contrast material(s)
	72146	Magnetic resonance (e.g., proton) imaging, spinal canal 
			and contents, thoracic; without contrast material
	72147		with contrast material(s)
	72148	Magnetic resonance (e.g., proton) imaging, spinal canal 
			and contents, lumbar; without contrast material
	72149		with contrast material(s)
	72156	Magnetic resonance (e.g., proton) imaging, spinal canal 
			and contents, without contrast material, followed by 
			contrast material(s) and further sequences; cervical
	72157		thoracic
	72158		lumbar
72195	Magnetic resonance (e.g., proton) imaging, pelvis; without contrast  material(s)
	72196		with contrast material(s)
	72197		without contrast material(s), followed by contrast 
			material(s) and further sequences
	73218	Magnetic resonance (e.g., proton) imaging, upper extremity, 
			other than joint; without contrast material(s)	
				
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Service Codes	Service
for Freestanding	Code	Service Description
MRI Centers
(cont.)	73219		with contrast material(s)
	73220		without contrast material(s), followed by contrast 
			material(s) and further sequences
	73221	Magnetic resonance (e.g., proton) imaging, any joint of 
			upper extremity; without contrast material(s)
	73222		with contrast material(s)
	73223		without contrast material(s), followed by contrast 
			material(s) and further sequences
	73718	Magnetic resonance (e.g., proton) imaging, lower extremity 
			other than joint; without contrast material(s)
	73719		with contrast material(s)
	73720		without contrast material(s), followed by contrast 
			material(s) and further sequences
	73721	Magnetic resonance (e.g., proton) imaging, any joint of 
			lower extremity; without contrast material
	73722		with contrast material(s)
	73723		without contrast material(s), followed by contrast 
			material(s) and further sequences
	73725	Magnetic resonance angiography, lower extremity, with or 
			without contrast material(s) 
	74181	Magnetic resonance (e.g., proton) imaging, abdomen; without 
			contrast material(s)
	74182		with contrast material(s)
74183		without contrast material(s), followed by with contrast material(s) and further sequences
	74185	Magnetic resonance angiography, abdomen, with or 
			without contrast material(s) 
	75552	Cardiac magnetic resonance imaging for morphology; 
			without contrast material
	75553		with contrast material
	75554	Cardiac magnetic resonance imaging for function, with or without morphology; complete study
	75555		limited study
	75556	Cardiac magnetic resonance imaging for velocity flow mapping
	76375	Coronal, sagittal, multiplanar, oblique, three-dimensional 
and/or holographic reconstruction of computed tomography, magnetic resonance imaging, or other tomographic modality
	 76393	Magnetic resonance guidance for needle placement (e.g., for 
			biopsy, needle aspiration, injection, or placement of 
	localization device) radiological supervision and	interpretation
	76394	Magnetic resonance guidance for, and monitoring of, visceral tissue ablation
		
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Fee Schedule	If you wish to obtain a fee schedule, you may purchase Division of Health 
Care Finance and Policy regulations from either the Massachusetts State Bookstore or from the Division of Health Care Finance and Policy (see addresses and telephone numbers below).  You must contact them first to find out the price of the publication.  The Division of Health Care Finance and Policy also has the regulations available on disk.  Rates for FMRI centers are found in 114.3 CMR 18.00:  Radiology. 

		Massachusetts State Bookstore	
		State House, Room 116	
		Boston, MA  02133	
		Telephone:  617-727-2834	
		www.mass.gov/sec/spr

				Division of Health Care Finance and Policy
				Two Boylston Street
		Boston, MA  02116
			Telephone:  617-988-3100
		www.mass.gov/dhcfp

Questions	If you have any questions about the information in this bulletin, please call MassHealth Provider Services at 617-628-4141 or 1-800-325-5231