CPT 74263Radiology

Ct colonography screening

CPT 74263 covers CT colonography screening, a specialized CT scan used to screen for colon cancer and polyps without an invasive colonoscopy. This virtual colonoscopy uses computed tomography to create detailed images of the entire colon.

Showing rates for

National Average

Base Medicare rate

$699.98

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

2.28

PE RVU (NF)

19.27

MP RVU

0.09

Total RVU

21.64

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

NCCI bundling edits

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Billing tips

Verify that the patient meets screening criteria (asymptomatic, no recent colonoscopy, age-appropriate) before performing the exam, as Medicare only covers 74263 for true screening in average-risk patients
Impact: Prevents denials worth $699.98; incorrect use of screening code when diagnostic criteria present results in 85% denial rate
Do not bill 74263 if patient has gastrointestinal symptoms, positive FOBT/FIT, or history of polyps - use diagnostic code 74261 or 74262 instead with appropriate diagnosis codes
Impact: Using wrong code type (screening vs diagnostic) causes automatic denials; diagnostic codes may have different coverage and require different diagnosis codes
Ensure both supine and prone imaging is documented in the report, as single-position CT colonography does not meet the standard of care for 74263
Impact: Incomplete protocol may trigger medical review and potential denial; both positions are required for full $699.98 reimbursement
Bill globally (without modifiers) when performed in freestanding imaging center where same entity owns equipment and provides interpretation
Impact: Maximizes reimbursement at $699.98; unnecessary modifier 26 or TC reduces payment by splitting components
Document any findings requiring follow-up colonoscopy clearly, as subsequent optical colonoscopy within 4 years may affect future CT colonography screening eligibility
Impact: Affects patient eligibility for repeat screening; inadequate documentation of positive findings can create compliance issues for future claims
Verify commercial payer policies separately, as many still do not cover CT colonography screening despite Medicare coverage since 2021

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74263 in 2025?

The 2025 Medicare national average payment for CPT 74263 is $699.98 for both facility and non-facility settings. This is based on 21.64 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 74263 and 74261?

CPT 74263 is specifically for screening CT colonography in asymptomatic, average-risk patients with diagnosis code Z12.11. CPT 74261 is for diagnostic CT colonography without contrast in patients with symptoms, positive screening tests, polyp surveillance, or other clinical indications requiring diagnostic imaging. Using the wrong code based on clinical scenario results in claim denials.

How often does Medicare cover CT colonography screening with code 74263?

Medicare covers CT colonography screening (74263) once every 5 years for beneficiaries aged 45 and older who are at average risk for colorectal cancer and asymptomatic. This is less frequent than the 10-year interval for optical colonoscopy screening. Diagnostic CT colonography (74261/74262) follows different coverage rules based on clinical necessity.

Can CPT 74263 be billed with modifier 26 for professional component only?

Yes, modifier 26 should be appended to 74263 when the radiologist provides only the professional interpretation service but does not own the imaging equipment, such as hospital-employed radiologists. The facility separately bills the technical component with modifier TC. When billed in a freestanding center where the same entity provides both components, bill globally without modifiers for the full $699.98.

What diagnosis code should be used with CPT 74263 for screening?

The primary diagnosis code for screening CT colonography (74263) should be Z12.11 (encounter for screening for malignant neoplasm of colon). Using symptom codes, positive test result codes, or personal history codes instead will cause the claim to deny as screening is only covered for asymptomatic, average-risk patients without indication for diagnostic testing.

What are the RVU values for CPT 74263 in 2025?

CPT 74263 has 2.28 work RVUs, 19.27 practice expense RVUs (both facility and non-facility), and 0.09 malpractice RVUs, totaling 21.64 RVUs in 2025. This makes it one of the higher-valued radiology screening procedures, reflecting the complexity of interpretation and the advanced imaging technology required.

Do commercial insurance plans cover CPT 74263 for CT colonography screening?

Coverage varies significantly by commercial payer. While Medicare began covering 74263 in 2021, many commercial insurers still do not include CT colonography in their covered colorectal cancer screening options or require prior authorization. Always verify coverage and obtain pre-authorization before scheduling to avoid the $699.98 payment responsibility falling to the patient, which creates significant collection challenges.