CPT 70554
Global XXX ActiveFmri brain by tech
CPT 70554 Billing & Documentation Guide
CPT code 70554 (Fmri brain by tech) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.06, a non-facility practice expense RVU of 9.08, and a malpractice RVU of 0.17, a total non-facility RVU of 11.31 and facility RVU of 11.31. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $391.59, though rates vary from $332.25 to $516.75 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 70554, 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 70554 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 70554 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 70554
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.06 | 2.06 |
| Practice Expense RVU | 9.08 | 9.08 |
| Malpractice RVU | 0.17 | 0.17 |
| Total RVU | 11.31 | 11.31 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 70554
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 | $433.21 | $433.21 | $405.41 - $516.75 | 29 |
| Florida | $384.15 | $384.15 | $367.28 - $398.88 | 3 |
| Georgia | $365.03 | $365.03 | $346.1 - $383.96 | 2 |
| Illinois | $372.95 | $372.95 | $354.58 - $390.82 | 4 |
| Michigan | $361.58 | $361.58 | $352.11 - $371.04 | 2 |
| North Carolina | $355.39 | $355.39 | $355.39 - $355.39 | 1 |
| New York | $418.12 | $418.12 | $360.91 - $444.35 | 5 |
| Ohio | $351.42 | $351.42 | $351.42 - $351.42 | 1 |
| Pennsylvania | $372.55 | $372.55 | $352.58 - $392.53 | 2 |
| Texas | $373.04 | $373.04 | $350.07 - $394.84 | 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 70554
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 70554 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 |
| 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 |
| 70551 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 70557 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 70558 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 70559 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 96020 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 70552 | Column 2 (secondary), bundled into primary | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 70554
What does CPT code 70554 mean? +
CPT code 70554 represents: Fmri brain by tech. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 70554? +
The 2026 Medicare national average non-facility payment for CPT 70554 is $391.59. Rates range from $332.25 to $516.75 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 70554? +
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 70554? +
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 June 2, 2026.
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