CPT 74283Radiology

Ther nma rdctj intus/obstrcj

CPT 74283 covers a therapeutic procedure where a radiologist uses imaging guidance and air or liquid contrast to gently push and unblock a telescoped intestine (intussusception) or other bowel obstruction without surgery.

Showing rates for

National Average

Base Medicare rate

$251.98

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

2.02

PE RVU (NF)

5.66

MP RVU

0.11

Total RVU

7.79

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

NCCI bundling edits

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Billing tips

Document therapeutic intent and actual reduction attempt in operative report, not just diagnostic imaging - must clearly state pressure applied, technique used, and outcome of reduction attempt
Impact: Prevents $251.98 denial and downcoding to diagnostic-only code 74270 ($89-125 typical reimbursement), protecting approximately $125-160 per claim
Bill as global service (no modifier) when performed in hospital setting where physician provides both professional and supervision components unless split billing arrangement exists
Impact: Ensures full $251.98 reimbursement rather than split between 26/TC components which may result in reduced total payment
Capture and document failed reduction attempts requiring surgical intervention - use modifier 53 and ensure clear documentation of attempt and reason for discontinuation
Impact: Recovers approximately 50% reimbursement ($126) for discontinued procedures rather than complete denial
For repeat attempts on same day, use modifier 76 with detailed documentation explaining why initial attempt failed and why repeat was medically necessary
Impact: Secures additional $125-252 depending on payer policy (50-100% of base rate) when properly documented
Verify pre-authorization requirements for non-emergent cases and document emergency status when applicable - many payers require prior auth but waive for true emergencies
Impact: Prevents 100% denial ($251.98 loss) due to authorization issues while maintaining rapid treatment in emergencies
Link to appropriate ICD-10 codes showing bowel obstruction or intussusception (K56.1, K56.69) and document clinical presentation supporting medical necessity

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74283 in 2025?

The 2025 Medicare national average reimbursement for CPT 74283 is $251.98 for both facility and non-facility settings. This rate is based on 7.79 total RVUs (2.02 work RVU, 5.66 PE RVU, 0.11 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can I bill CPT 74283 if the reduction attempt was unsuccessful?

Yes, CPT 74283 can be billed for unsuccessful reduction attempts as long as a legitimate therapeutic attempt was made using appropriate technique and fluoroscopic guidance. Documentation must clearly describe the reduction maneuvers attempted, pressures applied, and clinical reasons why the procedure was discontinued. Use modifier 53 if procedure was terminated before completion due to safety concerns.

What is the difference between CPT 74283 and 74270?

CPT 74283 is a therapeutic procedure for reducing intussusception or bowel obstruction using contrast enema under fluoroscopy, while 74270 is diagnostic-only radiologic examination of the colon. The key difference is therapeutic intent and technique - 74283 involves controlled pressure application to physically reduce the obstruction, not just visualize it. Reimbursement for 74283 ($251.98) is significantly higher than diagnostic codes.

Do I need a separate consent form for billing CPT 74283?

Yes, informed consent specifically addressing the therapeutic reduction procedure is required and essential for proper billing. The consent should cover procedure-specific risks including bowel perforation (2-3% risk), radiation exposure, need for emergency surgical intervention if unsuccessful or complications occur, and alternative treatment options. Generic imaging consent is insufficient for this therapeutic procedure.

Can CPT 74283 be billed with an E/M service on the same day?

Yes, but the E/M service must be separately identifiable and documented with modifier 25. The E/M should represent the evaluation and decision-making that led to the decision to perform the therapeutic reduction, not just pre-procedure assessment. Documentation must clearly show the E/M was a significant, separately identifiable service beyond the typical pre-procedure evaluation included in 74283.

How many times can I bill CPT 74283 on the same day?

Multiple attempts on the same day should typically be billed as one unit of 74283. However, if a truly separate and distinct second procedure is performed (not just continuation of initial attempt), use modifier 76 for repeat procedure by same physician. Documentation must justify why a separate attempt was medically necessary, such as recurrent intussusception hours after successful initial reduction. Most payers scrutinize multiple same-day billings heavily.

What diagnosis codes are required to support medical necessity for CPT 74283?

Primary diagnosis codes should indicate intussusception (K56.1) or other intestinal obstruction (K56.69, K56.60). Supporting secondary codes may include symptoms such as abdominal pain (R10.0-R10.9), vomiting (R11.1), or rectal bleeding (K62.5). Pre-procedure imaging findings confirming the obstruction should be documented in the medical record. Diagnosis coding must align with clinical presentation and imaging findings to establish medical necessity.