CPT 74235Radiology

Remove esophagus obstruction

CPT code 74235 covers a fluoroscopic procedure where a radiologist uses real-time X-ray imaging to guide the removal of an object or food stuck in the esophagus, typically by advancing it into the stomach.

Showing rates for

National Average

Base Medicare rate

$54.34

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

1.19

PE RVU (NF)

0.44

MP RVU

0.05

Total RVU

1.68

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

NCCI bundling edits

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Billing tips

Clearly document the therapeutic intent and fluoroscopic guidance throughout the procedure to distinguish from diagnostic esophagography (74210, 74220)
Impact: Prevents downcoding to diagnostic codes which may reimburse $10-20 less; critical for audit defense
Bill global code (no modifier) only when both professional and technical components are provided by the same entity
Impact: Ensures full $54.34 payment; incorrect modifier use can result in 40-60% payment reduction
Document all fluoroscopy time, attempts made, medications administered (glucagon), and final outcome in the interpretation report
Impact: Reduces denial risk by 70-80%; establishes medical necessity and differentiates from simple diagnostic studies
Do not separately bill for esophagography (74210, 74220) performed immediately before therapeutic intervention unless truly diagnostic and separate
Impact: Prevents unbundling denials and potential $80-100 recoupment; CCI edits bundle diagnostic with therapeutic
Verify that fluoroscopy equipment logging and radiation dose documentation meet state and CMS requirements
Impact: Avoids technical denials and potential compliance issues; required for medical necessity validation
When procedure is unsuccessful and patient requires endoscopy, ensure timing and separate documentation support both procedures
Impact: Supports payment for both services when appropriate; prevents bundling that could cost $54.34

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74235 in 2025?

The 2025 Medicare national average payment for CPT 74235 is $54.34 for both facility and non-facility settings, based on 1.68 total RVUs and the conversion factor of 32.3465.

What is the difference between CPT 74235 and diagnostic esophagography codes?

CPT 74235 is specifically for therapeutic fluoroscopic guidance during removal or advancement of an esophageal obstruction, while codes 74210 and 74220 are purely diagnostic studies to visualize esophageal anatomy and function without therapeutic intervention.

Can CPT 74235 be billed with an esophagogastroduodenoscopy (EGD) on the same day?

Yes, if the fluoroscopic procedure is attempted first and unsuccessful, followed by endoscopic removal, both can be billed with appropriate documentation showing medical necessity for both approaches. Use modifier 59 if needed to override bundling edits.

How many RVUs is CPT code 74235 worth?

CPT 74235 has 1.68 total RVUs for 2025, consisting of 1.19 work RVUs, 0.44 practice expense RVUs, and 0.05 malpractice RVUs.

Who can bill CPT code 74235?

CPT 74235 must be billed by or under the direct supervision of a licensed radiologist with fluoroscopy privileges who performs the interpretation. It is typically billed by diagnostic or interventional radiologists working in hospital or imaging center settings.

Do I need modifier 26 or TC when billing CPT 74235?

Use modifier 26 if billing only the professional component (physician interpretation), modifier TC for only the technical component (equipment and staff), or no modifier for global billing when the same entity provides both components.

What documentation is required to support medical necessity for CPT 74235?

Required documentation includes clinical presentation of dysphagia or obstruction, fluoroscopic visualization of the obstructing material, description of therapeutic intervention performed, fluoroscopy time, medications administered (such as glucagon), and the outcome of the procedure with physician signature.