Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
| Contract | Contractor | Type | States |
|---|---|---|---|
| 09101 | First Coast Service Options, Inc. | A and B MAC | FL |
| 09201 | First Coast Service Options, Inc. | A and B MAC | PR VI |
| 09102 | First Coast Service Options, Inc. | A and B MAC | FL |
| 09202 | First Coast Service Options, Inc. | A and B MAC | PR |
| 09302 | First Coast Service Options, Inc. | A and B MAC | VI |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A57779 (Billing and Coding: Magnetic Resonance Angiography (MRA)) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A57779: Billing and Coding: Magnetic Resonance Angiography (MRA) (Billing and Coding, effective 2025-01-01)
- Covered ICD-10-CM codes
- 1
- 1 group
- Non-covered ICD-10-CM codes
- 1
- Procedure codes listed
- 22
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| XX000 | — |
Procedure codes: 70544, 70545, 70546, 70547, 70548, 70549, 71555, 72198, 73725, 74185, C8900 (Magnetic Resonance Angiography With Contrast, Abdomen), C8901 (Magnetic Resonance Angiography Without Contrast, Abdomen), C8902 (Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Abdomen), C8909 (Magnetic Resonance Angiography With Contrast, Chest (Excluding Myocardium)), C8910 (Magnetic Resonance Angiography Without Contrast, Chest (Excluding Myocardium)), C8911 (Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Chest (Excluding Myocardium)), C8912 (Magnetic Resonance Angiography With Contrast, Lower Extremity), C8913 (Magnetic Resonance Angiography Without Contrast, Lower Extremity), C8914 (Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Lower Extremity), C8918 (Magnetic Resonance Angiography With Contrast, Pelvis), C8919 (Magnetic Resonance Angiography Without Contrast, Pelvis), C8920 (Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Pelvis).
Coverage indications, limitations and medical necessity
History/Background and/or General Information
Magnetic Resonance Angiography (MRA) is an application of magnetic resonance (MR) imaging that provides visualization of blood flow, as well as images of normal and diseased blood vessels. Since MRA contrast agents are not nephrotoxic and are rarely associated with allergic type reactions, MRA without or with gadolinium-based contrast enhancement is an imaging alternative for patients who cannot tolerate iodine-based contrast media.
Although MRA appears to be a rapidly developing technology, the clinical safety and effectiveness of this procedure for all anatomical regions has not been proven. As a result coverage will be provided on a limited basis. Below are the indications for coverage allowed for MRA. All other uses of MRA will not be covered.
Covered Indications
Please refer to CMS IOM Publication 100-03, Medicare National Coverage Determination (NCD) Manual , Chapter 1, Section 220.2 Magnetic Resonance Imaging for covered MRA Indications for Head and Neck, Peripheral Arteries of Lower Extremities, Abdomen and Pelvis, and Chest.
MRA and contrast angiography (CA) are not expected to be performed on the same patient for diagnostic purposes prior to the application of anticipated therapy. Only one of these tests will be covered routinely unless the physician can demonstrate the medical need to perform both tests. The medical record must clearly document the medical necessity of performing both tests.
Examples of indications that support medical necessity of contrast angiography (CA) performed as an adjunct to MRA:
• Clarify conditions where test results or clinical information are contradictory (e.g., MRA and duplex Doppler ultrasound are discordant with the clinical differential diagnosis and conventional angiography, with its ability to directly measure pressure gradients across stenosis of questionable hemodynamic significance, can provide more definitive information).
• Verify the site of clinically important vascular stenosis and help map out the surgical/endovascular approach (e.g., to determine which lesions should have an angioplasty and/or stent vs. which lesions require surgical bypass graft or no treatment at all).
• Identify situations where MRA is nonconclusive or degraded by metallic artifact.
Abdomen and Pelvis
Studies show that diagnostic evaluation of several upper abdominal malignancies may require an evaluation for vascular invasion by the tumor in deciding if the patient is a candidate for surgical resection of the tumor. One example is with pancreatic carcinoma. Pancreatic head carcinomas can grow in close proximity to the superior mesenteric vein.
Evidence suggests that MRA provides reliable, noninvasive evaluation of the portal and hepatic veins. MRA can provide focused evaluation of particular areas of interest as well as a broad overview anatomic display that is helpful to surgeons and interventionalists planning procedures.
As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual , Chapter 13, Section 13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary.
Summary of evidence (opening)
N/A
the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2020-07-01
- Last reviewed by the contractor
- 2017-09-21
- MCD version
- 22
- Derived from
- L28903
The contractor lists one National Coverage Determination as related: NCD 220.2 Magnetic Resonance Imaging. Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the First Coast Service Options, Inc. hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L34372 cover?
Magnetic Resonance Angiography (MRA) is an application of magnetic resonance (MR) imaging that provides visualization of blood flow, as well as images of normal and diseased blood vessels. Since MRA contrast agents are not nephrotoxic and are rarely associated with allergic type reactions, MRA without or with gadolinium-based contrast enhancement is an imaging alternative for patients who cannot tolerate… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L34372 apply to?
First Coast Service Options, Inc. applies it to Medicare claims in FL, PR, VI. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L34372?
The companion billing and coding article A57779 lists 1 ICD-10-CM codes in 1 group that support medical necessity and 1 that do not; the first 1 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L34372?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.