Cardiac magnetic resonance imaging (CMR) has become an essential non-invasive diagnostic tool for evaluating myocardial structure, function, perfusion, viability, congenital heart disease, cardiac masses, pericardial disease, and infiltrative cardiomyopathies. Because cardiac MRI is one of the highest-cost advanced imaging exams and has multiple CPT pathways—including contrast-enhanced, non-contrast, add-on flow codes, and congenital-specific codes—it is frequently audited by Medicare and commercial plans.
Accurate billing requires a detailed understanding of the CPT structure, technical vs professional components, documentation elements, and payer medical necessity rules.
This guide provides a comprehensive overview of CPT coding, documentation requirements, indications, contrast billing, common denials, and compliance recommendations for cardiac MRI in 2024–2025.
Overview of Cardiac MRI CPT Codes
Cardiac MRI codes fall into several categories based on whether the study is with contrast, without contrast, or includes flow/velocity measurements. Cardiac MR angiography (MRA) is separately coded and cannot be billed together with standard cardiac MRI codes.
Cardiac MRI Without Contrast
75557 – Cardiac MRI without contrast material, including morphology and function
Used when:
- Basic structural and functional assessment
- Suspected cardiomyopathy
- Ventricular function assessment without the need for perfusion or late gadolinium enhancement
Cardiac MRI With Contrast & Follow-Up Sequences
75561 – Cardiac MRI with contrast, including morphology, function & delayed enhancement
Used for:
- Myocardial viability
- Infiltrative cardiomyopathies (amyloidosis, sarcoidosis)
- Myocarditis
- Scar evaluation
- Post-MI viability assessment
This is the most commonly billed cardiac MRI code.
Cardiac MRI Without + With Contrast
75565 – Add-on for velocity/flow mapping (must be used with 75557 or 75561)
This is not a standalone code.
Used to assess:
- Valvular regurgitation or stenosis
- Shunt fraction (Qp/Qs)
- Aortic flow abnormalities
Congenital Heart Disease MRI
75563 – Cardiac MRI for congenital heart disease, without contrast, including morphology & function
75564 – Congenital MRI with contrast & follow-up sequences
Congenital studies are more complex and include detailed anatomic assessments (PA branches, arch anomalies, shunts, baffles), making them high audit targets.
Cardiac MR Angiography Codes (MRA)
Cardiac MRI and cardiac MRA cannot be billed together if they evaluate the same anatomic region during the same session.
Non-coronary Cardiac MRA Codes
- 71555 – MRA of the chest
- Used when evaluating the thoracic aorta, pulmonary arteries, and mediastinum
- 74185 – MRA of the abdomen
- Used when evaluating the abdominal aorta or visceral branches
These codes are common in aortic dissection, coarctation, or congenital anomalies.
Important rule:
If a payer determines that MRA sequences are part of the cardiac MRI protocol, it may bundle 71555 into the cardiac MRI CPT code. Clear documentation of purpose and findings is required to justify a separate payment.
Professional vs Technical Component Billing
Cardiac MRI services can be billed as:
- Global service (facility + physician)
- Professional component (modifier 26) – Interpretation
- Technical component (modifier TC) – Scanner, technologist, equipment
Examples:
- Hospital outpatient: technical billed by facility; interpretation billed by cardiologist/radiologist using 75561-26
- Office/IDTF: global billing with 75561 unless split billing is contractually required
Documentation must clearly reflect who performed what.
Required Documentation Elements
A complete cardiac MRI report must include the following elements for proper billing and medical necessity support:
Clinical Indication
Should describe:
- Symptoms
- Suspected diagnosis
- Reason MRI is preferred over echo/CT
- Prior imaging results
Payers require MRI to be “medically necessary,” not purely routine.
Technique
Must specify:
- Type of scanner (1.5T or 3T) – not mandatory but strongly recommended
- Sequences performed (cine imaging, T1/T2 mapping, LGE, perfusion, flow mapping, etc.)
- Whether gadolinium contrast was used
- Whether flow studies were performed (supports 75565)
Contrast Documentation
Should include:
- Name of gadolinium agent
- Dose administered
- Route (IV)
- Any contrast reactions
- Medical justification for contrast use
Contrast is essential for billing 75561 or 75564.
Functional Measurements
Include:
- LV/RV volumes, mass, ejection fraction
- Wall motion assessment
- Valve assessment (qualitative; quantitative if flow mapping performed)
- Regional abnormalities
These are required components of cardiac MRI CPT definitions.
Morphologic Findings
Report must include:
- Myocardial thickness
- Chamber size
- Infiltrative features
- Pericardial abnormalities
- Masses/thrombus
- Aortic & pulmonary artery dimensions (when relevant)
Late Gadolinium Enhancement (LGE)
If contrast is used, document:
- Pattern (subendocardial, transmural, mid-wall, patchy, diffuse)
- Distribution
- Consistency with ischemic vs non-ischemic pathology
- This supports 75561 medical necessity.
Flow/Velocity Measurements (75565)
Documentation must show:
- Specific vessels measured (Ao, PA, AV, MV, shunt)
- Purpose (severity of regurgitation, Qp/Qs, etc.)
- Quantitative results
Final Impression
Should provide:
- Diagnostic conclusion
- Interpretation of findings relative to indications
- Clinical recommendations
Medical Necessity Requirements
Medicare and commercial payers expect cardiac MRI to be used for specific, evidence-based indications. Common approved indications include:
Myocardial Evaluation
- Cardiomyopathy (ischemic, non-ischemic, infiltrative, hypertrophic)
- Myocarditis
- LV thrombus detection when the echo is inconclusive
Viability Assessment
- Post-MI viability
- Pre-revascularization evaluation
Congenital Heart Disease
- Complex congenital anatomy
- Shunt quantification
- Post-surgical evaluation
Assessment of Masses/Thrombus
When echo or CTA is inconclusive.
Pericardial Disease
- Pericarditis
- Constrictive pericarditis evaluation
- Pericardial masses
Aortic and Vascular Evaluation
Often billed via 71555, but sometimes under congenital MRI, depending on the indication.
Documentation must reflect WHY MRI is chosen instead of echo or CT.
Common Denials and How to Prevent Them
1. Lack of Clear Medical Necessity
A vague indication, such as “abnormal echo” or “chest pain,” is insufficient.
Solution: Include specific findings or suspected disease process.
2. Incorrect Use of Congenital vs Non-Congenital Codes
75563/75564 requires documentation of known or suspected congenital disease.
Otherwise, use 75557/75561.
3. Billing Flow Mapping (75565) Without Documentation
Payers deny add-on codes if the report does not explicitly state flow or velocity quantification.
4. Missing Contrast Details
75561 and 75564 require contrast administration documentation.
5. Billing Cardiac MRA Separately Without Justification
If MRA sequences (aorta, pulmonary arteries) are integral to the cardiac MRI protocol, they may be bundled.
6. Professional vs Technical Split Billing Errors
Hospitals bill TC; physicians bill 26.
Errors cause automatic payer denials.
7. Missing Signature
The final report must be signed by the interpreting physician.
Appropriate Use of Modifiers
Modifier 26 – Professional Component
Use when a cardiologist/radiologist interprets an MRI performed in a hospital or IDTF.
Modifier TC – Technical Component
Used by facilities performing the scan when interpretation is billed separately.
Modifier 59/XS
Rarely used in cardiac MRI.
Could apply if MRI and MRA of different regions are done in distinct sessions.
Modifier 76/77
Repeat MRI the same day—must justify clinical reason.
Modifier KX
Used for Medicare LCD compliance when required.
Best Practices for Cardiac MRI Documentation
Use standardized reporting templates.
Including:
- Indication
- Technique
- Findings by category
- LGE findings
- Flow quantification
- Impression
Include prior imaging comparison.
Supports the necessity for MRI.
Ensure the report matches the CPT code.
Example: If coded 75561, must include contrast + delayed enhancement.
Maintain a clear linkage between indications and findings.
Auditors want to see why the MRI was clinically important.
Document why MRI is needed over alternatives
Not required by CPT but often required by payers.
Compliance Recommendations for Practices
- Maintain an internal cardiac MRI checklist for reports.
- Ensure technologist worksheets include contrast dose, timing, and sequences.
- Validate medical necessity before the scan is scheduled.
- Train physicians on the documentation required for the 75565 add-on code.
- Perform quarterly internal audits for cardiac MRI claims.
- Clarify whether MRI scans are interpreted by cardiologists or radiologists for proper split billing.
Many practices also work with experienced coding partners such as Global Tech Billing LLC to maintain consistent documentation and accurate billing workflows.
FAQs
1. What is the most commonly billed cardiac MRI code?
75561, which includes contrast and delayed enhancement.
2. When should 75565 be billed?
Only when flow/velocity quantification is performed and documented.
3. Can cardiac MRI and MRA be billed together?
Yes, but only if evaluating distinct anatomic regions and documentation supports separate necessity.
4. What documentation is required for a cardiac MRI with contrast?
Contrast type, dose, timing, and delayed enhancement findings.
5. When are congenital MRI codes appropriate?
When evaluating known or suspected congenital heart disease.
6. Are diagnostic tests bundled into cardiac MRI?
No, ECG, echo, and other testing remain separately billable.
7. Is a signed interpretation required?
Yes, all imaging claims require a signed final report.
8. Is cardiac MRI always covered by payers?
Coverage depends on medical necessity and prior authorization policies.
