CPT 74240Radiology

X-ray xm upr gi trc 1cntrst

CPT 74240 is an X-ray examination of the upper gastrointestinal (GI) tract using a single contrast material, typically barium, to visualize the esophagus, stomach, and duodenum. This imaging study helps diagnose conditions like ulcers, reflux, strictures, or swallowing problems.

Showing rates for

National Average

Base Medicare rate

$117.09

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

0.8

PE RVU (NF)

2.77

MP RVU

0.05

Total RVU

3.62

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

NCCI bundling edits

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Billing tips

Clearly document single-contrast versus double-contrast technique in the radiology report
Impact: Prevents confusion with CPT 74246 (double-contrast) which has different reimbursement; coding errors can trigger $20-30 payment adjustments or denials
Verify that only the upper GI tract was examined; if small bowel follow-through was included, use CPT 74250 instead
Impact: CPT 74250 reimburses higher for extended study; undercoding 74240 when 74250 is appropriate costs approximately $50-80 per case
Split bill professional and technical components when radiologist is not employed by facility
Impact: Ensures both entities receive appropriate payment; failure to split can result in 100% payment loss for one party
Obtain prior authorization from Medicare Advantage and commercial payers before scheduling
Impact: Prevents denials averaging $117.09 per case; many payers require pre-auth for all GI contrast studies effective 2025
Document medical necessity with specific signs/symptoms; avoid vague indications like 'abdominal pain' without further detail
Impact: Reduces denial rate by 30-40%; specific documentation of dysphagia, hematemesis, or suspected stricture supports medical necessity
Bill on date of service (DOS) when images are acquired, not when final report is signed
Impact: Prevents timely filing denials; some payers have 90-day filing limits from actual service date

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74240 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 74240 is $117.09 for both facility and non-facility settings. This rate is based on 3.62 total RVUs multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 74240 and 74246?

CPT 74240 is for upper GI X-ray with single contrast (typically barium alone), while CPT 74246 is for upper GI with double contrast (barium plus air or gas). The technique must be clearly documented in the radiology report, as coding the wrong procedure can result in payment adjustments or denials.

Can CPT 74240 be billed with an endoscopy on the same day?

Yes, CPT 74240 can be billed with an endoscopy (such as 43235) on the same day if both procedures are medically necessary and clinically appropriate. Consider using modifier 59 on the radiographic study to indicate a distinct procedural service, and ensure documentation supports the need for both diagnostic modalities.

How many RVUs is CPT code 74240 worth?

CPT 74240 has 3.62 total RVUs in 2025, consisting of 0.8 work RVUs, 2.77 practice expense RVUs (both facility and non-facility), and 0.05 malpractice RVUs according to the CMS Physician Fee Schedule.

Does CPT 74240 require prior authorization from Medicare?

Traditional Medicare does not require prior authorization for CPT 74240, but Medicare Advantage plans and commercial insurers increasingly require pre-authorization for GI imaging studies. Always verify requirements with the specific payer before scheduling the procedure to avoid denials.

What diagnosis codes support medical necessity for CPT 74240?

Common supporting ICD-10 codes include R13.10 (dysphagia), K21.9 (gastroesophageal reflux disease), K29.70 (gastritis), R10.13 (epigastric pain), K92.0 (hematemesis), K22.2 (esophageal obstruction), and R63.0 (anorexia/weight loss). Documentation must connect the specific diagnosis to the need for upper GI imaging.

Can CPT 74240 be split-billed between professional and technical components?

Yes, CPT 74240 can be split into professional component (modifier 26 for radiologist interpretation) and technical component (modifier TC for equipment and technologist services). This is common when the radiologist and imaging facility are separate entities, ensuring both receive appropriate reimbursement portions.