CPT 74246Radiology

X-ray xm upr gi trc 2cntrst

CPT code 74246 is an X-ray examination of the upper gastrointestinal tract using air and barium contrast to create detailed images of the esophagus, stomach, and first part of the small intestine.

Showing rates for

National Average

Base Medicare rate

$132.30

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

0.9

PE RVU (NF)

3.14

MP RVU

0.05

Total RVU

4.09

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

NCCI bundling edits

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Billing tips

Ensure documentation clearly specifies 'double-contrast' or 'air-contrast' technique with description of both air and barium administration
Impact: Prevents downcoding to 74241 (single contrast at lower reimbursement) - potential loss of $20-30 per claim
Code separately for professional (26) and technical (TC) components when physician and facility are different entities
Impact: Ensures both providers receive appropriate reimbursement without claim rejection for duplicate billing
Document complete examination of esophagus, stomach, and duodenum with permanent recorded images for all anatomic areas
Impact: Incomplete documentation can trigger modifier 52 application reducing payment by $33-66
Do not bill 74246 with 74241 on same date of service for same anatomic area unless separate diagnostic purposes are clearly documented
Impact: Bundling edits will deny one code entirely; use modifier 59 only with compelling medical necessity documentation
Verify patient fasting status and include in documentation as proper preparation is required for diagnostic quality and medical necessity
Impact: Improves study quality reducing need for repeat examinations and associated costs; supports medical necessity on audit
Link appropriate ICD-10 diagnosis codes that support medical necessity such as dysphagia (R13.10), GERD (K21.9), or abdominal pain (R10.13)
Impact: Prevents denials for lack of medical necessity which account for 15-20% of initial claim rejections for this code

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Frequently asked questions

What is the difference between CPT 74246 and 74241?

CPT 74246 is an upper GI series using double-contrast technique (both air and barium) providing enhanced mucosal detail, while 74241 uses single-contrast (barium only). The double-contrast study (74246) reimburses at $132.30 and requires documentation of both contrast agents, whereas 74241 is a simpler study with lower reimbursement.

How much does Medicare pay for CPT code 74246 in 2025?

Medicare pays $132.30 for CPT 74246 in 2025 based on the national average rate. This applies to both facility and non-facility settings as the rates are identical at $132.30. The code has a total RVU of 4.09 (0.9 work RVU, 3.14 practice expense RVU, 0.05 malpractice RVU).

Can CPT 74246 be billed with modifier 26?

Yes, CPT 74246 can be billed with modifier 26 for the professional component only when a radiologist interprets films taken at a separate facility. The facility bills the technical component with modifier TC. Never bill the global code and a modified code for the same service.

What diagnosis codes support medical necessity for CPT 74246?

Common supporting diagnosis codes include dysphagia (R13.10-R13.19), gastroesophageal reflux disease (K21.0, K21.9), epigastric pain (R10.13), peptic ulcer disease (K27.x), hematemesis (K92.0), dyspepsia (K30), and iron deficiency anemia suggesting GI blood loss (D50.x). Screening codes (Z12.x) are typically not covered.

Is CPT 74246 bundled with upper endoscopy on the same day?

CPT 74246 and upper endoscopy (43235) are not automatically bundled by NCCI edits, but payers may deny one as duplicative without clear documentation of distinct medical necessity. Use modifier 59 on 74246 and document why both studies were required (e.g., endoscopy unsuccessful, different clinical questions, or complementary information needed).

What are the RVUs for CPT code 74246?

CPT 74246 has a total RVU of 4.09 for 2025, consisting of 0.9 work RVU, 3.14 practice expense RVU (both facility and non-facility), and 0.05 malpractice RVU. Using the 2025 conversion factor of 32.3465, this yields the Medicare rate of $132.30.

How should I bill CPT 74246 if the patient cannot complete the full exam?

If the double-contrast upper GI exam cannot be completed due to patient intolerance, medical contraindication, or technical issues, append modifier 52 (reduced services) to CPT 74246. Document specifically what portions were completed and why the full examination could not be performed. Reimbursement will be reduced proportionally, typically 25-50% depending on what was accomplished.