Coding and Payment for Magnetic Resonance Angiography (MRA)
Effective for claims with dates of service on and after June 3, 2010, CMS permits local Medicare contractors to cover (or not cover) all indications of MRA that are not specifically nationally covered or nationally non-covered. CMS has created the six Level II HCPCS codes in Table 5 below to allow ASCs to bill for certain MRA services that were previously non-covered but may now be covered at local Medicare contractor discretion. These HCPCS codes are assigned ASC PI=Z2 (Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight) with the update to the Medicare physician fee schedule authorized for June 1 through November 30, 2010, under the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010. The six Level II HCPCS codes must be used in place of existing CPT codes for the previously non-covered MRA procedures due to a statutory requirement that the OPPS provide payment for imaging services provided with contrast and without contrast through separate payment groups. Specifically, HCPCS codes C8931, C8932, and C8933 replace CPT code 72159 (Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s)), while HCPCS codes C8934, C8935, and C8936 replace CPT code 73225 (Magnetic resonance angiography, upper extremity, with or without contrast material(s)).
Further information on billing and coverage for MRA is available to contractors in Transmittal 123 (CR7040), issued July 9, 2010.
Table 5 – Carrier Determination MRA Codes Effective June 3, 2010
|Payment Indicator Effective 06/03/10
|Magnetic resonance angiography with contrast, spinal canal and contents
|MRA, w/dye, spinal canal
|Magnetic resonance angiography without contrast, spinal canal and contents
|MRA, w/o dye, spinal canal
|Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents
|MRA, w/o&w/dye, spinal canal
|Magnetic resonance angiography with contrast, upper extremity
|MRA, w/dye, upper extremity
|Magnetic resonance angiography without contrast, upper extremity
|MRA, w/o dye, upper extr
|Magnetic resonance angiography without contrast followed by with contrast, upper extremity
|MRA, w/o&w/dye, upper extr
The fact that a drug, device, procedure or service is assigned a HCPCS code and a payment rate under the ASC payment system does not imply coverage by the Medicare program, but indicates only how the product, procedure, or service may be paid if covered by the program. Carriers/Medicare Administrative Contractors (MACs) determine whether a drug, device, procedure, or other service meets all program requirements for coverage. For example, Carriers/MACs determine that it is reasonable and necessary to treat the beneficiary’s condition and whether it is excluded from payment.