CPT 74270Radiology

X-ray xm colon 1cntrst std

CPT code 74270 covers an x-ray examination of the colon (large intestine) using a single contrast agent, typically a barium enema. This is a radiological imaging procedure where contrast material is introduced into the colon to help visualize abnormalities, blockages, or structural issues on x-ray images.

Showing rates for

National Average

Base Medicare rate

$146.21

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

1.04

PE RVU (NF)

3.43

MP RVU

0.05

Total RVU

4.52

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

NCCI bundling edits

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Billing tips

Distinguish clearly between 74270 (single-contrast) and 74280 (double-contrast/air-contrast) barium enema techniques in documentation and coding
Impact: Incorrect code selection can result in $50-70 payment difference and trigger automated denials requiring appeals
Verify medical necessity documentation includes specific clinical indication beyond 'abdominal pain' - specify symptoms like hematochezia, suspected obstruction, or follow-up of known pathology
Impact: Vague indications account for 35-40% of denials; proper documentation prevents $146.21 write-off per claim
When billing split components (26/TC), ensure the facility and physician use the same CPT code and modifiers are applied correctly to avoid coordination of benefits issues
Impact: Component billing mismatches delay payment 30-60 days and may result in one component being denied entirely
Check for prior authorization requirements with commercial payers, as many now require pre-certification for non-emergency gastrointestinal imaging studies
Impact: Lack of authorization is leading denial reason for commercial payers, resulting in 100% claim denial despite medical necessity
Document fluoroscopy time and number of images obtained, as insufficient documentation may trigger downcoding or requests for medical records review
Impact: Inadequate procedure documentation increases audit risk and can delay payment by 45-90 days during review
Bill 74270 only once per encounter regardless of number of views; multiple views are included in the procedure code and should not be separately reported

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74270 in 2025?

The 2025 Medicare national average payment rate for CPT 74270 is $146.21 for both facility and non-facility settings. This rate is based on 4.52 total RVUs (1.04 work RVU, 3.43 practice expense RVU, 0.05 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary based on geographic locality adjustments.

What is the difference between CPT 74270 and 74280?

CPT 74270 is for a single-contrast barium enema where only barium sulfate is used to coat the colon, while CPT 74280 is for a double-contrast (air-contrast) barium enema where both barium and air are introduced to provide better mucosal detail. The double-contrast technique (74280) is more comprehensive and typically reimbursed at a higher rate, so proper documentation of the actual technique used is essential for correct coding.

Can CPT 74270 be billed with a colonoscopy on the same day?

Billing both procedures on the same day is unusual and likely to trigger denials due to duplication of services. If both are medically necessary for distinct clinical indications (such as barium enema for suspected obstruction preventing complete colonoscopy), append modifier 59 to indicate a distinct procedural service and provide detailed documentation explaining the medical necessity for both procedures. Most payers consider these procedures mutually exclusive for the same indication.

Does CPT 74270 require prior authorization?

Prior authorization requirements vary by payer. While Medicare typically does not require prior authorization for 74270, many commercial insurance plans and Medicare Advantage plans do require pre-certification for non-emergency gastrointestinal imaging studies. Always verify authorization requirements with the specific payer before scheduling the procedure to avoid denials.

What diagnosis codes support medical necessity for CPT 74270?

Common supporting diagnoses include chronic constipation (K59.09), change in bowel habits (R19.4), hematochezia (K92.1), suspected intestinal obstruction (K56.60), diverticulosis (K57.30), inflammatory bowel disease screening, and post-surgical evaluation. The diagnosis must justify why a barium enema is appropriate rather than colonoscopy or CT imaging. Vague codes like 'abdominal pain' alone often result in medical necessity denials.

How do I bill the professional and technical components separately for 74270?

To split-bill components, the physician bills CPT 74270-26 for the professional component (interpretation and report), while the facility bills 74270-TC for the technical component (equipment, supplies, staff). The global service (74270 with no modifier) should only be billed when one entity owns both components. Ensure coordination between facility and physician billing to prevent duplicate or missing components.

What are the work RVUs for CPT code 74270?

CPT code 74270 has 1.04 work RVUs, 3.43 practice expense RVUs (non-facility), 3.43 practice expense RVUs (facility), and 0.05 malpractice RVUs for a total of 4.52 RVUs in 2025. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024. Work RVUs reflect the physician time, technical skill, and intensity required to perform and interpret the study.