Blue Cross & Blue Shield of MississippiAll Plans · Administrative · Medical Policy · Neurology, Neurosurgery, RadiologyMedium impact
Functional Magnetic Resonance Imaging of the Brain for Presurgical Mapping or Seizure Focus Localization
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Functional MRI of the brain may be considered medically necessary as a complementary test in the preoperative evaluation of individuals with refractory epilepsy or brain tumors who are candidates for neurosurgery when the lesion is in close proximity to an eloquent area of the brain (for example, one controlling verbal or motor function) and testing is expected to have an important role in assessing the spatial relation between the lesion and the eloquent brain area. Functional MRI is considered investigational for all other applications. The 01/31/2025 policy update changed the title to add presurgical mapping or seizure focus localization and changed the medical policy number to L.6.01.423, with the policy statements unchanged.
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01Billing team: Bill functional MRI of the brain (CPT 70554, 70555) and neurofunctional testing (CPT 96020) as medically necessary only for the preoperative evaluation described in the policy, namely individuals with refractory epilepsy or brain tumors who are candidates for neurosurgery when the lesion is in close proximity to an eloquent brain area.
02The source states that these codes are ONLY medically necessary if the procedure is performed according to the Policy section.
03Treat all other applications of functional MRI as investigational and do not bill them as medically necessary.
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