fMRI Workflow and Billing

Lubdha M. Shah, MD

Key Facts

Billing Concepts

CPT values and descriptors
70554
- fMRI, including test selection and administration of repetitive body part movement &/or visual stimulation, not requiring physician or psychologist administration
- Not to be reported in conjunction with 96020 or 70555
70555
- fMRI requiring physician or clinical psychologist administration of entire neurofunctional testing
- Can only be reported when 96020 is performed
96020
- Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping
- Test administered entirely by a physician or clinical psychologist, with review of results and report
- 70554 and 70555 not to be reported in conjunction with 70551-53 unless a separate diagnostic MRI is performed

American College of Radiology Practice Guideline

Physician supervising and interpreting fMRI must be clinically informed and understand the specific questions to be answered in order to plan and perform the study safely and effectively
Assessment of intracranial tumoral disease
- Presurgical planning
- Assessment of eloquent cortex (e.g., language, sensory motor, visual) in relation to a tumor
- Surgical planning (biopsy or resection)
Assessment of language function for epilepsy surgery

Commercially available FDA-approved fMRI systems offer “turnkey” paradigm-delivery and data-acquisition solutions. Clinical fMRI studies may be streamlined with various well-documented motor, language, and visual paradigms and by technologists doing a large portion of the postprocessing. BOLD image processing is typically ≤ 1 hour. 3D fused DTI and BOLD datasets and postprocessed images can be delivered not only to PACS but also to neuronavigation systems for intraoperative guidance.

TERMINOLOGY

Abbreviations