Effective Sept. 1, 2023, NC Medicaid will cover functional magnetic resonance imaging (fMRI). Functional magnetic resonance imaging, as opposed to structural magnetic resonance imaging, measures brain function through changes in blood flow and oxygen delivery, an effect referred to as the BOLD (blood oxygenation level dependent) effect. This allows the mapping of neural networks in the brain based on function rather than structure.
Providers will be able to bill the following procedure codes for fMRI:
- 70554 - Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration
- 70555 - Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing
- 96020 - Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or psychologist, with review of test results and report
Contact
NCTracks Call Center: 800-688-6696