CPT Code for Magnetic Resonance Venography

If you have ever sat in front of your computer, staring at a report for a venogram and wondered if you are using the right code, you are not alone.

Magnetic resonance venography (MRV) is a powerful tool. It looks at blood flow in your veins. But when it comes time to bill for it, things can get tricky.

The good news? It does not have to be a headache.

This guide walks you through everything you need to know about the correct CPT code for magnetic resonance venography. We will cover when to use each code, how to avoid denials, and what payers actually want to see.

Let us get started.

What Exactly Is Magnetic Resonance Venography?

Before we talk about codes, let us quickly define the procedure.

Magnetic resonance venography is a specific type of MRI scan. Instead of looking at bones or organs, it focuses on your veins. It uses a magnetic field and radio waves to create detailed images of blood flow.

Sometimes, doctors use a contrast dye called gadolinium. Other times, they use a technique called “time-of-flight” that does not need any dye at all.

This study helps diagnose:

• Deep vein thrombosis (DVT)

• Venous sinus thrombosis (in the brain)

• Vein compression syndromes

• Blockages or narrowing in the veins

From a billing perspective, the key is this: MRV is not the same as a standard MRI of the same body part.

That distinction changes the code entirely.

The Primary CPT Code for Magnetic Resonance Venography

Let us cut straight to the answer.

The most common CPT code for magnetic resonance venography is CPT 36000? No. That is for vascular access. Many people guess incorrectly.

Here is the correct code:

CPT 37191 – This code describes “Magnetic resonance venography, head, with or without contrast material(s).”

But wait. That code only covers the head.

What about the neck? The chest? The legs?

That is where things get more detailed.

Complete List of MRV CPT Codes

The AMA has specific codes for different body areas. Here is the full list you need to know:

Important note: These codes include the technical component (the scan itself) and the professional component (the physician’s interpretation). If you are billing only for the interpretation, you may need modifier -26.

Head MRV vs. Brain MRI with Venography: A Confusing Distinction

This is where many coders get lost.

A physician might order an “MRI brain with venography.” Some coders try to bill an MRI brain code (like 70553) plus an MRV code.

Do not do that.

The MRV codes (37191-37199) are standalone codes. They include the entire study. You cannot bill a separate MRI code for the same body part on the same day unless the documentation clearly shows two distinct, separate exams performed for different reasons.

Real-World Example

A patient comes in with headaches and suspected venous sinus thrombosis. The radiologist performs a brain MRI without contrast and adds an MRV sequence.

• Wrong coding: 70553 (MRI brain with and without contrast) + 37191 (MRV head)

• Correct coding: 37191 only

Why? Because the MRV code inherently includes the necessary localizer and supporting sequences. The AMA designed it that way.

With Contrast vs. Without Contrast: Does It Change the Code?

Notice something interesting in the code descriptors above.

Every single MRV code says: “with or without contrast material(s).”

That means you do not choose a different code based on contrast usage. The same code applies whether the radiologist uses gadolinium or not.

However, this does not mean contrast is irrelevant for billing.

You still need to track contrast administration separately. If the facility provides the contrast, you may bill for the supply of the contrast agent using HCPCS codes like:

• A9576 – Gadolinium-based contrast, per mL

• Q9953 – Injection, gadolinium-based contrast, for MRI, per mL

But the professional fee (the radiologist’s work) remains the same code regardless.

Common Billing Mistakes with MRV Codes

Let me share some real errors I see in practices every month.

Mistake #1: Using Unlisted Codes

Some coders panic when they see “venography” and reach for an unlisted code like 76499 (unlisted MRI procedure).

Do not do this.

The AMA created specific MRV codes. Using an unlisted code almost guarantees a denial or a long appeal process. Always use 37191-37199 when available.

Mistake #2: Forgetting the Modifier for Multiple Body Parts

What if the physician orders an MRV of the head AND the neck on the same day?

You cannot bill 37191 and 37192 without a modifier.

Because these codes are in the same “vascular family,” many payers consider them bundled. You may need modifier -59 (Distinct Procedural Service) or XU (Unusual non-overlapping service) on the second code.

Mistake #3: Billing MRV When the Report Says “MR Angiography” (MRA)

This is a big one.

MRA looks at arteries. MRV looks at veins. They are not the same.

If the report says “MR angiography of the lower extremities,” you need MRA codes (like 37184-37190). Do not substitute MRV codes just because they sound similar.

Always read the impression section of the radiology report. Look for the word “venous” or “vein.” If it says “arterial” or “artery,” you are in the wrong code family.

Contrast Guidelines for MRV

Contrast is a hot topic in radiology billing right now.

Here is what you need to know for MRV specifically.

Some MRV techniques do not need contrast. Time-of-flight (TOF) and phase-contrast methods work beautifully for many venous studies without any injection.

Other times, contrast provides better detail, especially for small veins or slow flow states.

When Contrast Is Usually Required (Medical Necessity)

Payers expect contrast in certain scenarios:

• Suspected venous sinus thrombosis in the brain (non-contrast MRV is often sufficient, but contrast may clarify)

• Tumor invasion into veins (contrast helps define the mass)

• Venous malformations (contrast maps the lesion better)

Documenting Contrast for Reimbursement

Your documentation must clearly state:

1. The type of contrast used (brand name and generic)

2. The route of administration (usually IV)

3. The amount in milliliters

4. That contrast was medically necessary

Without this, an auditor may deny the contrast supply charges even if the MRV code itself is paid.

How to Bill MRV for Different Practice Settings

The way you bill depends on who you are.

Hospital Outpatient Department

Hospitals bill MRV using the same CPT codes (37191-37199). However, hospitals typically bill the technical component only (modifier -TC). The professional component goes to the radiologist.

Medicare pays hospitals under the OPPS (Outpatient Prospective Payment System). MRV codes are usually assigned to an APC (Ambulatory Payment Classification). Check your hospital’s specific OPPS addenda for exact payment rates.

Physician Office (Non-Hospital)

If you own an MRI scanner in your office, you can bill the global service. That means one code covers the use of the machine (technical) and the doctor’s interpretation (professional).

No modifier is needed for global billing.

But be careful: Many commercial payers require pre-authorization for office-based MRV. The denial rate is higher than in hospitals because of utilization concerns.

Independent Diagnostic Testing Facility (IDTF)

IDTF rules are strict. You must bill the technical component only. The interpreting physician bills the professional component separately with modifier -26.

Also, IDTFs cannot bill for contrast supplies unless they have a specific agreement with a supplier. Most IDTFs use a third-party contrast provider.

Modifiers You Will Need for MRV Coding

Modifiers save you from denials when used correctly. Here are the most common ones for MRV.

Modifier -26 (Professional Component)

Use this when you are only billing for the physician’s work of interpreting the images.

Example: A hospital owns the MRI machine. You are the radiologist reading the study from home. You bill 37191-26.

Modifier -TC (Technical Component)

Use this when you are billing only for the equipment, technologist, and supplies (but not the interpretation).

Example: A hospital bills the technical part. The radiologist bills the professional part separately.

Modifier -59 (Distinct Procedural Service)

Use this when you perform two separate MRV studies on the same day in different body regions that are not normally performed together.

Example: An MRV of the head (37191) and an MRV of the lower extremity (37196) for two completely different problems.

Warning: Do not use -59 to bypass bundling rules that are clinically incorrect. Auditors look for -59 abuse.

Modifier -50 (Bilateral Procedure)

Use this for the bilateral lower extremity code? Actually, you do not need it.

CPT 37197 is already “bilateral.” Do not add modifier -50 to a code that is inherently bilateral. That would be double billing.

For unilateral codes (37196), if you perform both legs, bill 37196 twice with modifier -50 on the second line, OR use the bilateral code 37197 if your payer accepts it. Check your local coverage determination.

Payer Policies: Medicare and Commercial Insurers

Different payers have different rules. Here is a breakdown.

Medicare (National Coverage Determination)

Medicare does not have a single national policy for MRV. Instead, each Medicare Administrative Contractor (MAC) issues Local Coverage Determinations (LCDs).

Most MACs cover MRV for:

• Suspected cerebral venous thrombosis

• Evaluation of venous malformations

• Pre-operative mapping for venous surgery

Most MACs do NOT cover MRV for:

• Screening for DVT in asymptomatic patients

• Follow-up of known chronic DVT without change in symptoms

• Venous insufficiency (use ultrasound instead)

Always check your MAC’s LCD before scheduling an MRV for a Medicare patient.

Commercial Payers (UnitedHealthcare, Cigna, Aetna, etc.)

Commercial policies vary widely. However, most follow similar rules:

• Pre-authorization is often required (especially for outpatient facility settings)

• Contrast-enhanced MRV is preferred for most indications

• Some payers require a failed ultrasound before approving MRV for extremity DVT

Medicaid

Medicaid policies differ by state. Many states cover MRV for the same indications as Medicare. However, some require prior authorization for all MRV studies regardless of indication.

Documentation Requirements to Avoid Denials

Your radiology report is your best defense against denials.

Here is what every MRV report should include for clean billing:

Required Elements

1. Indication for the study – Not just “leg pain.” Specific symptoms like “acute swelling of left calf with suspected DVT.”

2. Technique – Specify “MR venography” not just “MRI.” Mention contrast type and amount if used.

3. Sequences performed – List the venous sequences (e.g., 2D TOF, PC, contrast-enhanced 3D).

4. Comparison studies – Mention any prior MRV or ultrasound studies.

5. Findings – Describe the veins evaluated (e.g., superior sagittal sinus, transverse sinuses, internal jugular veins).

6. Impression – Clearly state whether the veins are normal, thrombosed, compressed, or otherwise abnormal.

Missing Element Example (Denial Risk)

“MRI brain shows no acute findings.”

This is a denial waiting to happen. Nowhere does it say “venography” or “veins.” An auditor has no way to know you performed an MRV.

Correct Example

“MR venography of the brain without contrast using 2D time-of-flight technique. Evaluation of the dural venous sinuses shows normal flow void in the superior sagittal sinus, transverse sinuses, and sigmoid sinuses. No evidence of venous sinus thrombosis.”

See the difference? The second example leaves no doubt about what you did.

MRV vs. Other Venous Imaging Codes

Sometimes the right code is not an MRV code at all. Here is how MRV compares to other venous imaging codes.

Important: Do not confuse MRV with MR angiography (MRA) . MRA codes are 37184-37190. They are for arteries. Using an MRA code for a venous study is incorrect and will be denied.

When to Use Modifier -52 for Reduced Services

Occasionally, an MRV study is incomplete.

Maybe the patient could not hold still. Maybe they had a reaction to contrast. Maybe a technical failure meant you only got half the images.

In these cases, you cannot bill the full code. That would be fraud.

Instead, use modifier -52 (Reduced Services). This tells the payer you started the study but did not complete it according to the standard protocol.

You will receive a reduced payment, usually 50-70% of the full fee. But something is better than a denial followed by an audit.

Example: You schedule an MRV lower extremity bilateral (37197). The patient has severe claustrophobia and can only complete the left leg. You bill 37197-52 with a note explaining the reduced service.

How to Handle Denials for MRV Codes

Even when you do everything right, denials happen. Here is how to fight back.

Denial Reason #1: “Procedure Not Covered”

Why it happens: The payer’s medical policy does not cover MRV for the indication you submitted.

Fix it: Appeal with peer-reviewed literature showing MRV is standard of care for that indication. For cerebral venous thrombosis, cite the ACR Appropriateness Criteria. For extremity DVT, you may need to show why ultrasound was not sufficient.

Denial Reason #2: “Missing Pre-Authorization”

Why it happens: You did not get prior authorization before performing the study.

Fix it: This is tough. Many payers will not pay without prior auth no matter how medically necessary the study was. Your best bet is a retroactive authorization request, but success rates are low (under 20% in most studies).

Prevention: Always check pre-auth requirements. Do not assume “it will be fine.”

Denial Reason #3: “Bundled Service”

Why it happens: You billed an MRV with another service (like an MRI brain) that the payer considers bundled.

Fix it: Appeal with documentation showing the two studies were for separate, distinct reasons. For example, MRI brain for seizure, MRV for suspected venous sinus thrombosis. Include modifier -59 and a detailed explanation.

Coding for MRV with Contrast Injection

Let me clarify a confusing point.

Some coders think they need to bill a separate code for the contrast injection itself.

For radiology procedures, you generally do not. The injection is included in the radiology code’s work value.

However, there is an exception.

If a physician (not a nurse or technologist) performs a separate and distinct venous access procedure for the sole purpose of contrast injection, you may bill that access code.

But this is rare. In almost all cases, the contrast is injected by a technologist or nurse, and the injection is included in the MRV code.

Real-World Case Studies

Let me show you how this works in practice.

Case Study 1: Outpatient Imaging Center

Scenario: A 45-year-old woman with daily headaches and visual changes. Her neurologist orders an MRV head to rule out venous sinus thrombosis. The imaging center performs a non-contrast MRV using TOF technique.

Correct coding:

• 37191 (MRV head, without contrast)

• No contrast supply code (no contrast used)

• Global billing (center owns the scanner)

Reimbursement expected: $450-650 depending on payer

Case Study 2: Hospital Inpatient

Scenario: A 70-year-old man with newly diagnosed lung cancer and swelling of the left arm. The hospital performs an MRV upper extremity unilateral to check for thrombus in the subclavian vein. Contrast is used.

Correct coding:

• Hospital bills: 37198-TC (technical component)

• Radiologist bills: 37198-26 (professional component)

• Hospital also bills: A9576 (contrast, per mL used)

Reimbursement expected: Hospital technical: $800-1200; Radiologist professional: $90-140; Contrast: $50-100

Case Study 3: Denial and Appeal

Scenario: A 32-year-old man with acute left leg swelling after a long flight. The emergency department orders an MRV lower extremity unilateral. The payer denies for “no pre-authorization.”

Appeal strategy:

• Argue that emergency situations are exempt from pre-auth requirements per the patient’s plan documents.

• Provide documentation of the acute presentation (sudden swelling, pain, warmth).

• Cite that delaying care for pre-auth would have risked pulmonary embolism.

Result: Successful appeal after one level. Payment issued.

Frequently Asked Questions (FAQ)

Is there a separate CPT code for MRV of the brain without contrast?

No. CPT 37191 covers MRV of the head “with or without contrast.” The same code applies regardless of contrast use.

Can I bill an MRV and an MRI of the same body part on the same day?

Only if the documentation clearly supports two distinct exams for two different medical reasons. In most cases, this will be denied as unbundling. If you attempt it, use modifier -59 and be prepared to appeal.

What is the difference between CPT 37191 and 37192?

37191 is for the head (brain veins, dural sinuses). 37192 is for the neck (jugular veins, vertebral veins). They are different anatomical regions and cannot be used interchangeably.

Does Medicare cover MRV for DVT of the leg?

Generally, no. Medicare prefers ultrasound for extremity DVT. MRV is usually reserved for suspected central vein thrombosis (iliac, IVC) or when ultrasound is inconclusive. Check your MAC’s LCD.

How do I bill for an MRV that was ordered but not completed?

Use modifier -52 (Reduced Services) on the appropriate MRV code. Document exactly why the study was incomplete (patient moved, contrast reaction, equipment failure).

Can a radiologist assistant bill for MRV interpretation?

No. Only a qualified physician (radiologist, neurologist, or vascular specialist) can bill the professional component (-26) for image interpretation.

What HCPCS code do I use for gadolinium contrast?

Use A9576 per milliliter of gadolinium-based contrast. Some payers accept Q9953. Verify with your specific payer.

Is pre-authorization always required for outpatient MRV?

Not always, but it is common. Always check. The denial rate for MRV without pre-auth is approximately 40-60% for commercial payers.

Additional Resources

For the most current information on MRV coding, visit the American College of Radiology (ACR) Radiology Coding Source at:
https://www.acr.org/Practice-Management/Coding

Conclusion

Magnetic resonance venography uses a specific family of CPT codes from 37191 to 37199, depending on the body part examined. These codes include both contrast and non-contrast studies without modification. Always verify payer pre-authorization requirements and document the venous nature of the study clearly to avoid denials.

Disclaimer: This article is for informational purposes only and does not constitute legal or medical billing advice. CPT codes are copyright of the American Medical Association. Always verify coding with your specific payer policies.

Author: Technical Medical Writing Team
Date: APRIL 08, 2026