CPT 74262Radiology

Ct colonography dx w/dye

CPT code 74262 is for a CT colonography (also called virtual colonoscopy) performed with contrast dye to examine the colon and detect abnormalities like polyps or tumors using advanced imaging technology instead of a traditional scope.

Showing rates for

National Average

Base Medicare rate

$454.47

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

2.5

PE RVU (NF)

11.39

MP RVU

0.16

Total RVU

14.05

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

NCCI bundling edits

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Billing tips

Ensure documentation clearly states IV contrast was administered and specify the type and amount of contrast material used
Impact: Prevents downcoding to 74261 (without contrast) which would result in underpayment; proper documentation supports the $454.47 reimbursement
Verify the indication is diagnostic (not screening) as Medicare does not cover screening CT colonography under current policy
Impact: Prevents automatic denial; diagnostic indications include symptoms, follow-up of known disease, or incomplete conventional colonoscopy
Document both supine and prone positioning with adequate bowel preparation quality assessment in the radiology report
Impact: Meets documentation standards for complete CT colonography study; inadequate positioning documentation can trigger medical review and payment delays
Bill global service (without modifiers) when your facility provides both technical and professional components
Impact: Maximizes reimbursement at full $454.47 rate; splitting components unnecessarily can delay payment and increase administrative burden
Check for Medical Necessity with diagnoses like R19.5 (abnormal bowel sounds), K92.1 (melena), K63.5 (polyp of colon), or Z86.010 (personal history of colonic polyps)
Impact: Using appropriate ICD-10 codes prevents medical necessity denials; vague symptoms may trigger review or denial
Do not bill 74262 on the same day as screening colonoscopy code 74263 unless there is clear documentation supporting both as distinct services
Impact: Prevents bundling denials and potential fraud flags; CCI edits may bundle these services unless properly documented with modifier 59

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74262 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 74262 is $454.47 for both facility and non-facility settings. This rate is based on 14.05 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

Does Medicare cover CT colonography for screening purposes?

No, Medicare does not currently cover CT colonography (CPT 74262 or 74263) for routine colorectal cancer screening. Medicare only covers CT colonography when performed for diagnostic purposes in symptomatic patients or following an incomplete conventional colonoscopy. Documentation must clearly establish diagnostic medical necessity.

What is the difference between CPT 74262 and 74261?

CPT 74262 is CT colonography performed WITH intravenous contrast material, while CPT 74261 is performed WITHOUT contrast. The code selection depends on whether IV contrast was administered during the procedure. Both codes have the same 2025 Medicare reimbursement rate, but proper documentation of contrast administration is essential to support 74262.

Can CPT 74262 be billed with a conventional colonoscopy on the same day?

Generally no, unless there is clear documentation of medical necessity for both procedures as distinct services. The most common scenario is when conventional colonoscopy is incomplete due to anatomic factors, and CT colonography is performed to visualize the unexamined portion of the colon. In such cases, modifier 59 may be required and detailed documentation is essential.

What diagnosis codes support medical necessity for CPT 74262?

Diagnostic indications supporting CPT 74262 include K92.1 (melena), R19.5 (abnormal bowel sounds), K63.5 (polyp of colon), R10.9 (abdominal pain), K92.2 (GI hemorrhage), D12.6 (benign neoplasm of colon), K51 (ulcerative colitis), K50 (Crohn's disease), and Z86.010 (personal history of colonic polyps). Screening-related diagnosis codes will typically result in denial.

How many RVUs is CPT code 74262 worth?

CPT 74262 has 14.05 total RVUs in 2025, consisting of 2.5 work RVUs, 11.39 practice expense RVUs (both facility and non-facility), and 0.16 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Do I need to use modifiers 26 or TC when billing CPT 74262?

Only use modifier 26 (professional component) or TC (technical component) when the service is split between different entities. If your facility provides both the equipment/technologist and the physician interpretation, bill the global code 74262 without modifiers for the full $454.47 reimbursement. Split billing is common when hospital provides technical component and radiologist group bills professional component separately.