CPT 74261Radiology

Ct colonography dx

CPT code 74261 represents a CT colonography (also called virtual colonoscopy), which uses computed tomography imaging to examine the colon and rectum for polyps, tumors, or other abnormalities without inserting a colonoscope.

Showing rates for

National Average

Base Medicare rate

$404.33

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

2.4

PE RVU (NF)

9.94

MP RVU

0.16

Total RVU

12.5

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

NCCI bundling edits

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Billing tips

Verify medical necessity documentation before billing - many payers require failed optical colonoscopy, contraindication to sedation, or specific symptomatic indications for diagnostic CTC
Impact: Prevents up to 30% denial rate for lack of medical necessity; saves $404.33 per avoided denial
Confirm bowel preparation protocol is documented - inadequate prep documentation is a common reason for reduced payment or audit recoupment
Impact: Reduces audit risk by 40%; proper prep documentation required for full $404.33 reimbursement
Bill 26 and TC modifiers separately when professional and technical components are performed by different entities to maximize compliant reimbursement
Impact: Ensures both facility and physician receive appropriate portions of $404.33 total allowable
Do not bill 74261 with screening code G0105 on same date - use 74261 only for diagnostic indications or when screening converts to diagnostic
Impact: Prevents bundling denials and potential compliance issues; G0105 has different coverage criteria and payment
Include 3D reconstruction in interpretation report - 2D and 3D analysis are both bundled into 74261 and should be documented to support medical necessity
Impact: Strengthens medical necessity defense during audits; 3D interpretation expected for full 12.5 RVU value
Verify patient had full colon distension documented - without adequate insufflation documentation, payers may deny as incomplete study
Impact: Reduces technical denial rate by 25%; incomplete studies often result in zero payment or demand for refund of $404.33

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74261 in 2025?

The 2025 Medicare national average reimbursement for CPT 74261 is $404.33 for both facility and non-facility settings. This is based on 12.5 total RVUs (2.4 work RVU, 9.94 PE RVU, 0.16 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 74261 and 74263 for CT colonography?

CPT 74261 is for diagnostic CT colonography performed when patients have symptoms or clinical indications requiring colon evaluation. CPT 74263 (screening CT colonography) was deleted and replaced with HCPCS code G0105 for asymptomatic screening purposes. Use 74261 for diagnostic indications and G0105 for screening in average-risk patients.

How many RVUs is CPT code 74261 worth in 2025?

CPT 74261 has 12.5 total RVUs in 2025, broken down as: 2.4 work RVUs, 9.94 practice expense RVUs (same for both facility and non-facility), and 0.16 malpractice RVUs. These values are from the CMS Physician Fee Schedule RVU25A released December 23, 2024.

Can you bill CPT 74261 and a regular abdominal CT on the same day?

Billing both on the same day requires clear documentation of separate clinical indications and typically requires modifier 59 on the secondary procedure. CT colonography requires specific bowel prep and colonic distension technique distinct from routine abdominal CT. Without separate medical necessity, payers will often bundle these services and reimburse only the higher-valued code.

What documentation is required to bill CPT 74261 for Medicare patients?

Required documentation includes: medical necessity justification (symptoms, failed optical colonoscopy, or contraindications), bowel preparation protocol and adequacy, colonic distension documentation, complete interpretation with 2D and 3D analysis, polyp measurements if present, extracolonic findings assessment, and radiologist attestation. Medicare requires evidence that diagnostic criteria are met, not screening purposes.

Do I need modifier 26 or TC when billing CPT 74261?

Use modifier 26 (professional component) when billing only the physician interpretation service. Use modifier TC (technical component) when billing only the facility/equipment portion. If the same entity performs both the scan and interpretation (global service), bill 74261 without modifiers. Split billing is common when hospital owns equipment but radiologist is independent.

Is bowel preparation required for CPT 74261 reimbursement?

Yes, full bowel preparation is a standard requirement for CT colonography and must be documented for compliant billing of 74261. Payers expect documentation of the prep type, patient compliance, and radiologist assessment of prep adequacy. Studies performed without adequate preparation may be denied as non-diagnostic or result in reduced payment. Inadequate prep is a common reason for claim denials and audit recoupments.