CMS is proposing new Billing Codes for MRI in the draft 2025 Medicare Physician Fee Schedule to account for the extra work involved in safely performing MRIs on patients with implants or other factors that could pose risks.
These additional tasks might involve reviewing a patient’s medical history, researching implant specifics, carefully considering risks and benefits for high-risk patients, and planning safety measures for the MRI. They could also include programming MR-compatible devices (like pacemakers) before and after the exam, according to a radiology expert.
If approved, these codes would be a first for Medicare reimbursement, radiology expert explains. Currently, MRI providers who take on more complex cases aren’t compensated for the extra time and effort required to ensure patient safety for these challenging exams.
Changes made:
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- Replaced jargon like “contraindications” and “CPT codes” with clearer terms.
- Shortened and simplified sentences for easier reading.
- Highlighted the key points: new billing codes for complex MRIs and the lack of current compensation for these procedures.
The document proposes new Billing Codes for MRI (found on page 152) to account for the additional work involved in MRI safety for patients with implants or other concerns. Here’s a breakdown of the codes:
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- Codes 7XX00 & 7XX01: Trained staff assesses the implant’s safety for MRI. This includes researching the implant, checking its compatibility with MRI, and consulting professional guidelines. (7XX00 covers the initial 15 minutes, 7XX01 covers additional 30-minute blocks)
- Code 7XX02: A doctor or qualified healthcare professional reviews the implant’s safety for the specific MRI exam, weighs the risks and benefits, and determines the necessary equipment and expertise for a safe scan.
- Code 7XX03: A medical physicist or safety expert customizes the MRI exam based on the implant. This includes planning how to get the best images while considering the implant’s limitations and mitigating risks. A doctor then reviews and approves the plan.
- Code 7XX04: Under a doctor’s supervision, an MRI-compatible device like a pacemaker is programmed to ensure its safety during the scan. This protects the device, the patient from unintended stimulation, and prevents overheating.
- Code 7XX05: Under a doctor’s supervision, the patient with an implant is positioned and secured for the MRI. This involves using special measures to protect the implant from movement, magnetic effects, and radiofrequency burns.
These new Billing Codes for MRI would allow for separate billing for the extra time and effort involved in safely performing MRIs on patients with complex cases.
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