CPT 74280Radiology

X-ray xm colon 2cntrst std

CPT code 74280 covers a barium enema x-ray examination of the colon using two contrast materials to create detailed images. This diagnostic imaging procedure helps doctors visualize the large intestine to detect abnormalities, blockages, or diseases.

Showing rates for

National Average

Base Medicare rate

$208.63

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

1.26

PE RVU (NF)

5.11

MP RVU

0.08

Total RVU

6.45

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

NCCI bundling edits

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Billing tips

Always verify bowel preparation adequacy is documented before billing - inadequate prep resulting in non-diagnostic images is a primary denial reason
Impact: Prevents denials and requests for refund; can save the full $208.63 reimbursement per claim
Bill modifier 26 for professional component when performed in hospital setting where hospital bills TC separately - split billing maximizes appropriate reimbursement
Impact: Ensures proper component billing; professional component typically represents $83-104 of the total fee
Document medical necessity clearly when barium enema is performed instead of colonoscopy - note contraindications to colonoscopy or patient-specific factors
Impact: Reduces medical necessity denials by 60-75%; many payers prefer colonoscopy and scrutinize barium enema claims
Do not bill 74280 with screening diagnosis codes - use diagnostic codes showing signs/symptoms or personal history requiring diagnostic evaluation
Impact: Prevents automatic denials; screening colorectal exams are typically coded differently and may have different coverage rules
Include fluoroscopy time and number of images in documentation - this supports the double-contrast technique and differentiates from simpler studies
Impact: Strengthens claims during audit review; helps justify the 6.45 RVU value versus lower-valued single-contrast codes
When incomplete due to patient factors, use modifier 52 and document percentage completed and clinical information obtained
Impact: Can recover 50-75% of fee ($104-156) for partial studies versus complete denial; requires clear documentation of diagnostic yield

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74280 in 2025?

The 2025 Medicare national average reimbursement for CPT 74280 is $208.63 for both facility and non-facility settings. This is based on 6.45 total RVUs (1.26 work RVU, 5.11 practice expense RVU, 0.08 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 74270 and 74280?

CPT 74270 is a single-contrast barium enema using only barium, while CPT 74280 is a double-contrast study using both barium and air/gas. The double-contrast technique (74280) provides superior mucosal detail for detecting small polyps and early lesions, resulting in higher RVU values and reimbursement.

Can CPT 74280 be billed with modifier 26 for professional component only?

Yes, modifier 26 should be appended when billing only for the physician's interpretation and report, typically in hospital settings where the facility bills the technical component separately. This splits the reimbursement between professional and technical components, with the professional portion representing approximately 40-50% of the total fee.

How many RVUs is CPT code 74280 worth?

CPT 74280 has a total of 6.45 RVUs for 2025, consisting of 1.26 work RVUs, 5.11 practice expense RVUs (both facility and non-facility), and 0.08 malpractice RVUs according to the CMS Physician Fee Schedule.

Is CPT 74280 covered by Medicare for colorectal cancer screening?

CPT 74280 is not typically covered as a primary screening test for colorectal cancer under Medicare's screening benefit. It is covered as a diagnostic procedure when there are signs, symptoms, or specific clinical indications. Medicare preferentially covers colonoscopy, FIT testing, and other approved screening modalities for asymptomatic average-risk individuals.

What documentation is required to bill CPT 74280?

Required documentation includes ordering physician's medical necessity statement, patient consent, bowel prep adequacy assessment, confirmation that double-contrast technique (barium plus air) was used, fluoroscopic imaging details, number and types of views obtained, and a complete radiologist interpretation report covering all colonic segments with findings and impressions.

Can CPT 74280 be billed on the same day as a colonoscopy?

Generally no, unless there is distinct medical necessity for both procedures addressing different clinical questions. Most payers consider this duplicative since colonoscopy provides both visualization and therapeutic capability. If billed together, expect denials unless modifier 59 is used with exceptional documentation justifying both procedures, such as incomplete colonoscopy requiring barium study to visualize unreached segments.