CPT 70543
Global XXX ActiveMri orbt/fac/nck w/o &w/dye
CPT 70543 Billing & Documentation Guide
CPT code 70543 (Mri orbt/fac/nck w/o &w/dye) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.1, a non-facility practice expense RVU of 7.84, and a malpractice RVU of 0.15, a total non-facility RVU of 10.09 and facility RVU of 10.09. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $349.15, though rates vary from $297.66 to $458.15 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 70543, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 70543 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 70543 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 70543
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.1 | 2.1 |
| Practice Expense RVU | 7.84 | 7.84 |
| Malpractice RVU | 0.15 | 0.15 |
| Total RVU | 10.09 | 10.09 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 70543
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $385.23 | $385.23 | $361.02 - $458.15 | 29 |
| Florida | $342.63 | $342.63 | $328.01 - $355.41 | 3 |
| Georgia | $326.06 | $326.06 | $309.7 - $342.42 | 2 |
| Illinois | $332.99 | $332.99 | $317.05 - $348.44 | 4 |
| Michigan | $323.09 | $323.09 | $314.88 - $331.29 | 2 |
| North Carolina | $317.66 | $317.66 | $317.66 - $317.66 | 1 |
| New York | $372.41 | $372.41 | $322.43 - $395.29 | 5 |
| Ohio | $314.27 | $314.27 | $314.27 - $314.27 | 1 |
| Pennsylvania | $332.63 | $332.63 | $315.27 - $349.98 | 2 |
| Texas | $332.99 | $332.99 | $313.09 - $351.77 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 70543
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 70543 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01922 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36005 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 36011 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36406 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 70543
What does CPT code 70543 mean? +
CPT code 70543 represents: Mri orbt/fac/nck w/o &w/dye. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 70543? +
The 2026 Medicare national average non-facility payment for CPT 70543 is $349.15. Rates range from $297.66 to $458.15 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 70543? +
Radiology codes rely heavily on the professional/technical split: modifier 26 (professional component only) and TC (technical component only). Also common: 50 (bilateral imaging), 76 (repeat by same physician), 77 (repeat by different physician), and LT/RT for laterality.
What bundling edits apply to CPT 70543? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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