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2025 CPT code 76498

Unlisted magnetic resonance procedure used for diagnostic or interventional purposes when no other specific code applies.

CPT guidelines emphasize that code 76498 should be used only when no other code accurately represents the service provided. Detailed documentation supporting the medical necessity and the unique nature of the service is essential for proper reimbursement.

Modifiers may be applicable depending on the specific circumstances of the procedure.Consult the CPT manual and payer specific guidelines.

Medical necessity must be clearly established and documented. This includes a detailed explanation of the patient's symptoms, the rationale for using MRI, and how the results of the unique MRI procedure guided further management.

The physician or other qualified healthcare professional performing and interpreting the MRI.

IMPORTANT:Use only when no other specific CPT code accurately reflects the performed MRI procedure.Consider Category III codes if available.

In simple words: This code is used when an MRI scan is done that doesn't have a specific billing code. It covers both scans used to find out what's wrong and scans used as part of a treatment.

CPT code 76498 represents an unlisted magnetic resonance (MR) procedure.It's a catch-all code for MR services not explicitly defined by other existing CPT codes.This code encompasses both diagnostic and interventional MRI procedures performed when a more specific code is unavailable.Accurate billing requires detailed documentation specifying the nature of the procedure, including the body region, techniques used, and clinical indication.

Example 1: A patient presents with atypical symptoms suggestive of a rare nerve condition.A specialized MRI sequence, not covered by a standard CPT code, is used to visualize specific nerve structures, leading to a diagnosis. Code 76498 is used to bill for this unique procedure., An interventional MRI procedure is performed to guide the placement of a targeted drug delivery system into a deep brain structure. Because this technique is not described in specific CPT codes, code 76498 is used for billing purposes., A patient is scheduled for a radiation treatment planning MRI of the prostate.A specialized protocol is used to enhance tumor delineation, and code 76498 is applied to bill for this specialized MRI protocol not covered by typical diagnostic codes.

* Detailed description of the performed MRI procedure.* Justification for using the unlisted code 76498, explaining why no other CPT code is appropriate.* Body region imaged.* Imaging sequences and techniques used.* Clinical indication for the procedure.* Report interpretation with findings.

** This code requires a high level of documentation to justify medical necessity and accurately reflect the service performed.Submit a detailed explanation of the procedure and its clinical rationale with the claim to ensure proper reimbursement.Always cross-reference with current payer guidelines and any applicable NCCI edits to prevent claim denials.

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