Which payers have published criteria for MRI brain without and with contrast (CPT 70553)?

The imaging guidelines used by Aetna, Anthem BCBS, Cigna, Medicare, UnitedHealthcare include criteria that apply to this study. Whether a specific patient's plan requires prior authorization depends on the plan, so confirm on the payer's portal or by phone before scheduling.

Who reviews prior authorization requests for MRI brain without and with contrast (CPT 70553)?

Most commercial payers hand imaging reviews to a radiology benefit manager. For the payers tracked here, requests are reviewed using guidelines from eviCore, Carelon, CMS, UnitedHealthcare / eviCore. The request is submitted through that organization's portal rather than the health plan's general line.

What should be in the clinical notes before requesting MRI brain without and with contrast (CPT 70553)?

Reviewers look for a recent office visit that documents the symptoms and how long they have lasted, exam findings, results of any earlier imaging, treatments already tried and how the patient responded, and the specific question the study is expected to answer. The diagnosis code on the request should match what the notes describe.

How much does MRI brain without and with contrast (CPT 70553) cost?

Across 1,063 hospitals that publish their negotiated rates, the median commercial insurance rate is $1,518, with the middle half of rates between $708 and $2,980. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if MRI brain without and with contrast (CPT 70553) is denied?

Read the denial letter for the stated reason, then request a peer-to-peer conversation between the ordering clinician and the reviewing physician, which often resolves missing-information denials. If that fails, file a written appeal that answers the stated reason directly and attach the supporting notes. The denial letter lists the deadline and where to send the appeal.

CPT 70553: MRI brain without and with contrast - Prior Authorization and Price

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CPT 70553

MRI of the brain is done both without and with contrast.

MRI Head & Neck

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	214 that name this code
Anthem BCBS	Carelon	Imaging of the brain effective Sep 19, 2026 Advanced imaging for vascular indications effective Sep 19, 2026 Oncologic imaging effective Apr 4, 2026 Imaging of the head and neck effective Apr 14, 2024	44 that name this code
Cigna	eviCore	Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	215 that name this code
Medicare	CMS	NCD 220.2: Magnetic Resonance Imaging effective Apr 10, 2018 L37373: MRI and CT Scans of the Head and Neck (Noridian Healthcare Solutions) effective Oct 23, 2025 L34425: Magnetic Resonance Imaging of the Head and Neck (Palmetto GBA) effective Mar 27, 2025	3 that name this code
Original Medicare does not run a prior authorization program for outpatient imaging; claims are judged against the coverage policies above. Medicare Advantage plans set their own prior authorization rules.
UnitedHealthcare	UnitedHealthcare / eviCore	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	214 that name this code

Guidelines collected from the payers' published documents on September 29, 2026. Payers revise these documents during the year. Open the guideline link to confirm the current version before you submit.

Conditions the guidelines address for this study

These are the clinical situations where payer guidelines discuss MRI brain without and with contrast. Each has its own criteria for when the study is considered appropriate.

Headache Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Cerebrovascular Disease Aetna · Cigna · UnitedHealthcare
CNS and Head Infection/Neuro-COVID-19 Aetna · Cigna · UnitedHealthcare
Mental Health Disorders and Mental Status Change Aetna · Cigna · UnitedHealthcare
Multiple Sclerosis (MS) and Related Conditions Aetna · Cigna · UnitedHealthcare
Ataxia Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Mild Cognitive Impairment (MCI) and Dementia Aetna · Cigna · UnitedHealthcare
Cerebral Aneurysm and AVM Aetna · Cigna · UnitedHealthcare
Chiari and Skull-Base Malformations Aetna · Cigna · UnitedHealthcare
Dizziness, Vertigo and Syncope Aetna · Cigna · UnitedHealthcare
Epilepsy/Seizures Aetna · Cigna · UnitedHealthcare
Eye Disorders and Visual Loss Aetna · Cigna · UnitedHealthcare
Facial Palsy (Bell's Palsy)/Hemifacial Spasm Aetna · Cigna · UnitedHealthcare
Hearing Loss and Tinnitus Aetna · Cigna · UnitedHealthcare
Neurosurgical Imaging Aetna · Cigna · UnitedHealthcare
Other Imaging Studies Aetna · Cigna · UnitedHealthcare
Pituitary, Sella, Hypothalamus Aetna · Cigna · UnitedHealthcare
Scalp and Skull Aetna · Cigna · UnitedHealthcare
Trigeminal Neuralgia and other Centrally Mediated Facial Pain Syndromes Aetna · Cigna · UnitedHealthcare
Acoustic Neuroma and Other Cerebellopontine Angle Tumors Aetna · Cigna · UnitedHealthcare
Arachnoid Cysts Aetna · Cigna · UnitedHealthcare
Cerebral Vasculitis Aetna · Cigna · UnitedHealthcare
Cranial Neuropathies Aetna · Cigna · UnitedHealthcare
Head and Facial Trauma Aetna · Cigna · UnitedHealthcare
Mastoid Disease or Ear Pain Aetna · Cigna · UnitedHealthcare
Movement Disorders Aetna · Cigna · UnitedHealthcare
Papilledema/Pseudotumor Cerebri Aetna · Cigna · UnitedHealthcare
Paresthesias and/or Weakness Aetna · Cigna · UnitedHealthcare
Pineal/Colloid Cysts Aetna · Cigna · UnitedHealthcare
Sinus and Facial Imaging Aetna · Cigna · UnitedHealthcare
Sleep-Related Imaging Aetna · Cigna · UnitedHealthcare
Taste and Smell Disorders Aetna · Cigna · UnitedHealthcare
CNS Tumors Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare
Melanomas and Other Skin Cancers Aetna · Cigna · UnitedHealthcare
Pediatric Stroke Aetna · Cigna · UnitedHealthcare
Pediatric Ear Disorders Aetna · Cigna · UnitedHealthcare
Pediatric Renal Tumors Aetna · Cigna · UnitedHealthcare
Pituitary Dysfunction Aetna · Cigna · UnitedHealthcare
Primary Central Nervous System Tumors Aetna · Cigna · UnitedHealthcare

Plus 95 more. Use the search below to find a specific condition.

Typical price

Commercial insurance, median

$1,518

Middle half of rates: $708 to $2,980

Medicare, hospital outpatient

$356

Facility payment

Medicare, physician fee schedule

$319

National, non-facility

Commercial figures come from negotiated rates published by 1,063 hospitals; Medicare figures from CMS fee schedules. Rates vary widely by hospital and plan. Pricing data from CenterIQ.

Get notified when the rules for this study change

Payers update imaging guidelines several times a year. We will email you when the criteria for MRI brain without and with contrast change.

CPT 70553: MRI brain without and with contrast - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

Imaging CPT Code Coverage Lookup

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CPT 70553: MRI brain without and with contrast - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

Related studies

Imaging CPT Code Coverage Lookup

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET