CPT 74251Radiology

X-ray xm sm int 2cntrst std

CPT 74251 is an X-ray examination of the small intestine using two different types of contrast material with standardized imaging protocols. This procedure helps doctors visualize the small bowel to diagnose conditions like Crohn's disease, tumors, or intestinal blockages.

Showing rates for

National Average

Base Medicare rate

$339.31

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

1.17

PE RVU (NF)

9.26

MP RVU

0.06

Total RVU

10.49

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

NCCI bundling edits

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Billing tips

Ensure documentation explicitly states 'dual-contrast' or 'two-contrast' technique was used, not just 'contrast study'
Impact: Prevents downcoding to 74250 (single contrast at lower RVU), protecting $30-50 in reimbursement per case
Document all phases of the examination including fluoroscopic time, number of images, and anatomic coverage from ligament of Treitz to ileocecal valve
Impact: Reduces audit risk and supports medical necessity; lack of detail is primary cause of denials representing 100% claim loss
Do not bill 74251 with upper GI series (74246-74249) on same date unless anatomically distinct or separate encounter with modifier 59
Impact: Prevents bundling denials; improper bundling results in loss of entire $339.31 reimbursement
Verify patient preparation protocols were followed (fasting status, bowel prep if ordered) and document in report
Impact: Inadequate preparation leading to non-diagnostic study and modifier 52 reduces payment by approximately $85-170
Bill facility and non-facility settings correctly; both reimburse at $339.31 for 74251 but component splits differ with modifiers
Impact: Incorrect place of service coding triggers payment adjustments and potential recoupment
Link appropriate ICD-10 codes that support medical necessity such as K50.x (Crohn's), K56.x (obstruction), or K63.x (other intestinal diseases)
Impact: Missing or non-specific diagnosis codes account for 15-25% of denials, delaying or preventing $339.31 payment

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74251 in 2025?

Medicare pays $339.31 for CPT 74251 in 2025 under the national average non-facility rate. This rate is the same for both facility and non-facility settings at $339.31, based on a total RVU of 10.49 and conversion factor of 32.3465.

What is the difference between CPT 74251 and 74250?

CPT 74251 is a small intestine X-ray using two contrast agents (dual-contrast technique), while 74250 uses only one contrast agent (single-contrast). The dual-contrast method in 74251 provides better mucosal detail and warrants higher reimbursement. Documentation must explicitly state two contrast agents were used to bill 74251.

Can CPT 74251 be billed with an upper GI series on the same day?

Generally no, unless there is a distinct separate session or separate clinical indication documented. If both are medically necessary on the same date, modifier 59 should be appended to indicate a distinct procedural service, with documentation supporting the separate medical necessity for each examination.

What are the work RVUs for CPT code 74251?

CPT 74251 has 1.17 work RVUs, 9.26 practice expense RVUs (both facility and non-facility), and 0.06 malpractice RVUs, totaling 10.49 RVUs for 2025. These RVU values determine the Medicare payment of $339.31 when multiplied by the 2025 conversion factor.

How should I bill CPT 74251 if the patient cannot tolerate the full exam?

Use modifier 52 (reduced services) if the examination was partially completed but still yielded diagnostic information. Use modifier 53 (discontinued procedure) if the exam was stopped due to patient safety concerns before diagnostic images were obtained. Both require detailed documentation explaining why the full procedure could not be completed.

What diagnosis codes support medical necessity for CPT 74251?

Common supporting ICD-10 codes include K50.x (Crohn's disease), K56.x (intestinal obstruction), K63.x (other intestinal diseases), K90.x (malabsorption), R10.x (abdominal pain), K92.x (GI bleeding), and D12.x (benign neoplasm of small intestine). The diagnosis must justify why dual-contrast small bowel imaging is clinically appropriate.

Do I need a separate consent form for billing CPT 74251?

While not specifically required for billing purposes, informed consent for contrast administration is a medical standard of care and should be documented. For billing, the key requirement is a physician order and medical necessity documentation. Lack of consent documentation could create audit vulnerabilities even if not a specific CPT billing requirement.