CPT 72194Radiology

Ct pelvis w/o & w/dye

CPT code 72194 is for a CT scan of the pelvis performed twice: first without contrast dye, then with contrast dye injected into a vein to highlight blood vessels and organs.

Showing rates for

National Average

Base Medicare rate

$246.48

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.22

PE RVU (NF)

6.33

MP RVU

0.07

Total RVU

7.62

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

Loading bundling edits…

Billing tips

Always document both pre-contrast and post-contrast imaging phases in the radiology report with specific technical parameters for each phase to justify 72194 instead of 72193
Impact: Prevents downcoding to 72193 (with contrast only) which reimburses at lower rate, protecting approximately $40-60 per claim
Verify contrast contraindications screening and informed consent are documented before procedure; include serum creatinine values for patients with renal risk factors
Impact: Prevents medical necessity denials and reduces audit risk; documentation deficiencies account for 15-20% of denials for contrast studies
Bill global code 72194 when facility owns equipment and provides interpretation; split with 26/TC modifiers when components are separate
Impact: Incorrect modifier use results in 30-40% payment reduction or complete denial; proper component billing ensures accurate $246.48 reimbursement
Do not bill 72194 with 72192 or 72193 for the same anatomical area on the same date of service without modifier 76/77 and compelling clinical justification
Impact: Bundling edits will deny secondary code; improper unbundling can trigger fraud review and recoupment of $200-300 per occurrence
Link appropriate ICD-10 diagnosis codes that support medical necessity for both phases; generic codes like R10.2 (pelvic pain) may require additional specificity
Impact: Medical necessity denials occur in 8-12% of contrast CT claims with insufficient diagnosis coding; proper coding prevents $246.48 loss per claim
For Medicare patients, ensure ordering physician documentation meets Appropriate Use Criteria (AUC) requirements and CDSM consultation is documented when applicable

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 72194?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the difference between CPT 72194 and 72193?

CPT 72194 includes CT imaging of the pelvis both without contrast and with contrast (dual-phase), while 72193 includes only imaging with contrast. Code 72194 is appropriate when pre-contrast images are medically necessary to establish baseline tissue density before contrast enhancement, such as evaluating for calcifications, hemorrhage, or characterizing lesions. The 2025 Medicare reimbursement for 72194 is $246.48.

How much does Medicare pay for CPT code 72194 in 2025?

Medicare pays $246.48 for CPT 72194 in 2025 based on the national average non-facility rate. This represents the global payment including both technical and professional components. The code has 7.62 total RVUs (1.22 work RVU, 6.33 practice expense RVU, 0.07 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can you bill 72194 and 74177 together?

Billing 72194 (CT pelvis without and with contrast) with 74177 (CT abdomen and pelvis with contrast) together is typically not appropriate as they represent overlapping anatomical areas. Code 74177 already includes the pelvis, so billing both would be considered duplicate billing. If both abdomen and pelvis are scanned with dual-phase protocol, consider 74178 (CT abdomen and pelvis without and with contrast) instead.

What diagnosis codes support medical necessity for CPT 72194?

Common ICD-10 codes supporting 72194 include malignant neoplasms of pelvic organs (C53-C58, C61, C67), secondary malignancies requiring staging, inflammatory conditions (K51, K57, K65), pelvic abscesses (K65.1), endometriosis (N80), ovarian masses (N83.2), hematuria (R31), and pelvic trauma (S39). Dual-phase imaging is typically justified for lesion characterization, vascular assessment, infection localization, or tumor staging where both baseline and enhanced imaging provide diagnostic value.

Do I need modifier 26 or TC when billing 72194?

Use modifier 26 when billing only the professional component (physician interpretation), typically in hospital settings where the facility owns the equipment. Use modifier TC for the technical component only (equipment, technologist, supplies). Bill 72194 without modifiers (global code) when the same entity provides both components, common in private imaging centers. Splitting components incorrectly can result in significant underpayment or overpayment.

What are the documentation requirements for billing 72194?

Required documentation includes clinical indication for dual-phase protocol, explicit statement that both non-contrast and post-contrast phases were performed, contrast type and volume, IV administration route, pre-procedure renal function screening, contrast allergy screening, informed consent, technical parameters for each phase, and radiologist interpretation comparing findings on both phases. Missing documentation of the pre-contrast phase commonly results in downcoding to 72193.

How many RVUs is CPT code 72194 worth in 2025?

CPT code 72194 has 7.62 total RVUs in 2025, comprised of 1.22 work RVUs, 6.33 practice expense RVUs (non-facility), and 0.07 malpractice RVUs. The facility practice expense RVU is also 6.33. These RVUs multiplied by the 2025 conversion factor of 32.3465 result in the Medicare payment of $246.48 for both facility and non-facility settings.