CPT 74178Radiology

Ct abd&plv wo cntr flwd cntr

CPT 74178 is a CT scan of the abdomen and pelvis performed without contrast first, then repeated with contrast material injected into a vein. This dual-phase imaging helps doctors see differences in how tissues absorb the contrast, making it easier to identify problems like tumors, infections, or blood vessel abnormalities.

Showing rates for

National Average

Base Medicare rate

$332.85

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

2.01

PE RVU (NF)

8.15

MP RVU

0.13

Total RVU

10.29

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

NCCI bundling edits

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Billing tips

Always verify that both non-contrast AND contrast phases were actually performed and documented before billing 74178
Impact: Billing 74178 when only a contrast-enhanced study was performed (74177) results in upcoding and potential $50-100 overpayment per claim, triggering audit flags and possible fraud investigation
Document the specific clinical indication requiring dual-phase imaging in the order and radiologist report
Impact: Medicare and commercial payers increasingly deny 74178 when medical necessity for both phases is not clearly established, potentially saving 15-20% of claims from denial
Bill 74178 as a global service (no modifier) only when your practice owns the equipment and employs both the technologist and interpreting radiologist
Impact: Incorrect component billing (failing to split 26/TC when appropriate) can result in overpayment demands averaging $200-250 per claim during audits
Do not bill 74178 separately when performed as part of a comprehensive CT scan that includes additional anatomic regions on the same date of service
Impact: Bundling rules may apply; verify CPT guidelines to avoid $332.85 denial and ensure appropriate use of combination codes when available
Ensure contrast administration documentation includes type, amount, route, time of administration, and any adverse reactions
Impact: Missing contrast documentation is a top-5 audit target and can result in downcoding to 74176 (without contrast), reducing reimbursement by approximately $80-120 per study
When billing for both abdomen and pelvis, confirm the field of view extends from the diaphragm to the symphysis pubis

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Applicable modifiers

Mod 26

When to use: Professional component only - when radiologist provides only the interpretation and report, but does not own the equipment or employ the technologist

Reimbursement impact: Reduces payment to professional component only (approximately 25-30% of total RVUs). The technical component (modifier TC) would be billed separately by the facility.

Mod TC

When to use: Technical component only - when billing for equipment, technologist, contrast materials, and overhead costs without the physician interpretation

Reimbursement impact: Reduces payment to technical component only (approximately 70-75% of total RVUs). The professional component would be billed separately by the interpreting physician.

Mod 59

When to use: Distinct procedural service - when billing 74178 with another procedure that might be considered bundled, but was performed as a separate, medically necessary service on the same day

Reimbursement impact: Prevents automatic denial for bundling issues. May trigger additional documentation review but preserves full reimbursement when appropriately applied.

Mod 76

When to use: Repeat procedure by same physician - when the same CT scan must be repeated on the same day due to technical issues, patient movement, or clinical indication requiring comparison

Reimbursement impact: Allows reimbursement for the repeated study when medically necessary. Requires clear documentation of why the repeat was necessary to avoid denial.

Mod 91

When to use: Repeat clinical diagnostic laboratory test - rarely applicable to imaging, but may be used when repeat imaging is ordered for monitoring clinical change during the same day

Reimbursement impact: Less commonly accepted for CT imaging than modifier 76. May face higher scrutiny and requires strong medical necessity documentation.

Mod 52

When to use: Reduced services - when the contrast phase cannot be completed due to patient allergy discovered during the procedure or other clinical contraindication, resulting in only the non-contrast phase being performed

Reimbursement impact: Reduces reimbursement proportionally (typically 20-50% reduction). Should be considered when only partial service completed; alternative is to bill a different code (74176 for CT abdomen/pelvis without contrast only).

Frequently asked questions

What is the difference between CPT 74178 and 74177?

CPT 74178 includes both a non-contrast phase and a contrast-enhanced phase of the abdomen and pelvis, while 74177 includes only the contrast-enhanced phase. Code 74178 requires documentation of both acquisitions and is typically used when baseline non-contrast images are medically necessary to characterize lesions, identify calcifications, or assess for hemorrhage before contrast administration.

How much does Medicare pay for CPT 74178 in 2025?

The 2025 Medicare national average payment for CPT 74178 is $332.85 for both facility and non-facility settings. This rate is based on 10.29 total RVUs (2.01 work RVU + 8.15 PE RVU + 0.13 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary based on geographic locality adjustments.

Can I bill CPT 74178 with modifier 26 for reading the scan?

Yes, radiologists who interpret the CT scan but do not own the equipment should bill CPT 74178 with modifier 26 (professional component). This indicates you are billing only for the interpretation and report, not the technical resources. The facility will separately bill 74178 with modifier TC (technical component) for the equipment, technologist, and supplies.

What diagnosis codes support medical necessity for CPT 74178?

Diagnosis codes supporting 74178 typically include abdominal pain (R10.x), suspected malignancy (C76.2, C78.x), known cancer requiring staging or surveillance, renal mass (N28.x, D30.x), liver lesions (D13.4, K76.x), unexplained weight loss (R63.4), hematuria (R31.x), and inflammatory bowel disease (K50.x, K51.x). Medical necessity for dual-phase imaging should be clearly documented in the clinical indication.

How do I prevent denials when billing CPT 74178?

To prevent denials: ensure both non-contrast and contrast phases are documented in the technologist protocol and radiologist report, verify medical necessity supports dual-phase imaging, confirm appropriate diagnosis codes are submitted, document contrast type/amount/route/time, obtain prior authorization if required by the payer, and ensure renal function was assessed before contrast administration. Complete documentation is essential for audit defense.

What is the RVU value for CPT 74178 in 2025?

CPT 74178 has a total RVU value of 10.29 in 2025, consisting of 2.01 work RVUs, 8.15 practice expense RVUs (both facility and non-facility), and 0.13 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Can CPT 74178 be billed with a chest CT on the same day?

Yes, CPT 74178 (CT abdomen/pelvis) can be billed separately from a chest CT (such as 71260, 71270) when both are medically necessary and documented as separate, distinct procedures. No modifier is typically required as these represent different anatomic regions. However, if a combined chest/abdomen/pelvis protocol was performed, different combination codes may apply, so verify the actual imaging protocol performed.