CPT 74220Radiology

X-ray xm esophagus 1cntrst

CPT code 74220 covers an X-ray examination of the esophagus (the tube connecting your throat to your stomach) using a single contrast agent, typically barium, which the patient swallows to make the esophagus visible on X-ray images.

Showing rates for

National Average

Base Medicare rate

$93.16

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

0.6

PE RVU (NF)

2.24

MP RVU

0.04

Total RVU

2.88

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

NCCI bundling edits

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Billing tips

Verify single versus double contrast documentation before coding - 74220 is single contrast only, while 74230 covers double contrast studies
Impact: Incorrect code selection can result in $30-50 payment variance and potential audit triggers for upcoding or downcoding
Split bill using 26 and TC modifiers when professional and technical components are performed by different entities
Impact: Ensures both radiologist and facility receive appropriate payment; prevents duplicate billing denials worth the full $93.16
Document all phases of examination including patient positioning, number of images, fluoroscopy time, and contrast type/amount administered
Impact: Complete documentation supports medical necessity and prevents denials; missing elements cause 15-25% of esophagram claim rejections
Check for LCD/NCD coverage requirements and obtain ABN when ordered for non-covered indications like routine screening
Impact: Prevents complete payment denial ($93.16 loss) and allows patient billing when Medicare non-covered services are clearly documented
Do not separately bill for contrast material - it is included in the 74220 allowable and reflected in the PE RVU of 2.24
Impact: Separate contrast billing (A9900-A9999, Q9950-Q9999) with 74220 will be denied as bundled; wastes billing resources and delays payment
Ensure supervising radiologist attestation is present in medical record for compliance with supervision requirements
Impact: Missing physician supervision documentation can trigger recoupment of entire payment during CERT or RAC audits

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74220 in 2025?

The 2025 Medicare national average payment for CPT 74220 is $93.16 for both facility and non-facility settings. This rate is calculated from 2.88 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 74220 and 74230?

CPT 74220 describes an esophagus X-ray using single contrast (barium only), while CPT 74230 covers a double-contrast study (both barium and air/effervescent agent). The double-contrast technique (74230) typically provides better mucosal detail and reimburses at a higher rate. Code selection must match the actual technique documented in the radiology report.

Can CPT 74220 be billed with an upper GI series on the same day?

Generally no, CPT 74220 is considered bundled when performed with comprehensive upper GI series codes (74246, 74247, 74249). The upper GI series includes esophageal imaging. Bill 74220 separately only when a focused esophagram is performed as a distinct procedure with separate medical necessity, properly documented, and with modifier 59 if appropriate.

How many RVUs is CPT code 74220 worth?

CPT 74220 has 2.88 total RVUs in 2025, consisting of 0.6 work RVU, 2.24 practice expense RVU, and 0.04 malpractice RVU. The PE RVU is identical for both facility and non-facility settings at 2.24, which is why the Medicare payment rate is the same ($93.16) regardless of setting.

What diagnosis codes support medical necessity for CPT 74220?

Common supporting diagnoses include R13.10-R13.19 (dysphagia), K21.0-K21.9 (GERD), K22.0-K22.9 (esophageal diseases including stricture, ulcer, obstruction), R12 (heartburn), R19.00 (intra-abdominal swelling), and C15.3-C15.9 (esophageal malignancy). Documentation must clearly link the symptom/condition to the medical necessity for esophageal imaging.

Do I need to bill separately for the barium contrast with 74220?

No, contrast material is included in CPT 74220 and should not be billed separately. The practice expense RVU of 2.24 already accounts for the cost of barium sulfate and other supplies. Attempting to bill contrast codes (HCPCS Q-codes or A-codes) separately will result in denials for bundling or duplicate services.

What modifiers are most commonly used with CPT 74220?

The most common modifiers are 26 (professional component only) when the radiologist bills only for interpretation, TC (technical component) when the facility bills for equipment and staff, and 59 (distinct procedural service) when medical necessity supports separate payment from potentially bundled procedures. Modifier 52 may be used for reduced services if the examination cannot be completed.