CPT 74248Radiology

X-ray sm int f-thru std

CPT 74248 covers an X-ray examination of the small intestine using a follow-through technique with a standard contrast material. The patient drinks a contrast solution and X-rays are taken at intervals as the material moves through the small bowel.

Showing rates for

National Average

Base Medicare rate

$78.93

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

0.7

PE RVU (NF)

1.69

MP RVU

0.05

Total RVU

2.44

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

NCCI bundling edits

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Billing tips

Document exact number of images obtained and specific time intervals between exposures throughout the follow-through sequence
Impact: Prevents downcoding to limited study codes; protects full $78.93 reimbursement versus $60-65 for incomplete studies
Always document the type and volume of contrast material administered (e.g., 450ml barium sulfate suspension)
Impact: Required for medical necessity; missing documentation leads to 15-20% denial rate on retrospective audits
Note fluoroscopy time separately if extended - may support additional procedure coding for extensive fluoroscopic guidance
Impact: When fluoroscopy exceeds standard time, may justify concurrent billing with appropriate modifiers, adding $30-50 in some cases
Verify that prior authorization was obtained for non-emergent studies as many payers require pre-approval for GI contrast studies
Impact: Lack of authorization results in 100% payment denial; appeals successful only 30-40% of time
Bill professional and technical components separately when services are split between radiologist and facility
Impact: Ensures accurate payment distribution; prevents overpayment recoveries and underpayment issues averaging $25-35 per claim
Document clinical indication with ICD-10 codes that support medical necessity (not screening) to avoid automatic denials
Impact: Screening indications typically not covered; appropriate diagnostic codes improve first-pass acceptance rate by 25-30%

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74248 in 2025?

The 2025 Medicare national average reimbursement for CPT 74248 is $78.93 for both facility and non-facility settings. This rate is based on 2.44 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality adjustment.

Can CPT 74248 be billed with an upper GI series on the same day?

CPT 74248 can be billed with upper GI series codes (74246, 74247) on the same day only when there is distinct clinical necessity and documentation supports separate examinations. Use modifier 59 to indicate a distinct procedural service. Many payers will bundle these procedures unless documentation clearly demonstrates different diagnostic purposes or separate anatomic evaluation beyond routine follow-through.

What is the difference between CPT 74248 and 74249?

CPT 74248 is a small intestine follow-through study using standard technique, while 74249 is the same examination with enteroclysis (direct instillation of contrast through a nasoenteric tube). Code 74249 involves more invasive placement of a tube beyond the ligament of Treitz and typically provides better bowel distention, commanding higher reimbursement due to increased complexity.

How many RVUs is CPT 74248 worth in 2025?

CPT 74248 has 2.44 total RVUs in 2025, consisting of 0.7 work RVUs, 1.69 practice expense RVUs (both facility and non-facility), and 0.05 malpractice RVUs. This RVU value reflects the professional and technical work involved in performing and interpreting the small bowel follow-through examination.

What diagnosis codes are typically used with CPT 74248?

Common ICD-10 codes paired with 74248 include K50.x (Crohn's disease), K56.x (intestinal obstruction), R10.x (abdominal pain), K90.x (malabsorption), K63.5 (polyp of colon), R19.4 (change in bowel habits), and C17.x (malignant neoplasm of small intestine). The diagnosis must support medical necessity for small bowel imaging rather than colonoscopy or other first-line studies.

Do I need prior authorization for CPT 74248?

Prior authorization requirements for CPT 74248 vary by payer and state. Most Medicare Advantage plans and many commercial payers require pre-authorization for non-emergent small bowel studies. Traditional Medicare does not require prior authorization but does require medical necessity. Always verify with the specific payer before scheduling to avoid payment denials.

What documentation is needed to bill CPT 74248 versus 74245?

CPT 74248 requires documentation of serial timed images following oral contrast through the entire small bowel (follow-through technique), while 74245 is an upper GI series focusing on esophagus, stomach, and duodenum only. Documentation must specify anatomic extent (including jejunum and ileum for 74248), number of images, contrast type, and time intervals. If only the upper GI tract is imaged without complete small bowel visualization, 74245 is the appropriate code.