CPT 74290Radiology

Contrast x-ray gallbladder

CPT code 74290 covers a specialized x-ray examination of the gallbladder using contrast material (dye) to make the organ visible on imaging. This procedure, called a cholecystography, helps doctors evaluate gallbladder function and detect problems like gallstones or inflammation.

Showing rates for

National Average

Base Medicare rate

$80.87

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

0.32

PE RVU (NF)

2.15

MP RVU

0.03

Total RVU

2.5

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

NCCI bundling edits

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Billing tips

Split professional and technical components correctly using modifiers 26 and TC when physician and facility bill separately
Impact: Prevents duplicate billing denials and ensures accurate reimbursement split; improper component billing can result in 100% denial
Document the medical necessity clearly since 74290 is often deemed obsolete by payers favoring ultrasound (76705) or HIDA scan (78226)
Impact: Reduces denial rate by 60-70%; without justification for choosing cholecystography over ultrasound, expect high denial rates
Verify LCD/NCD coverage criteria before performing as many Medicare contractors have specific limitations on cholecystography coverage
Impact: Prevents $80.87 write-off per study; obtaining ABN when coverage is uncertain protects revenue
Bill on the date of interpretation, not the date contrast was administered if these are different dates
Impact: Ensures timely filing compliance; backdating claims can trigger audit flags
Include ICD-10 codes that specifically justify functional gallbladder evaluation (K82.8, K82.9) rather than generic abdominal pain codes
Impact: Increases clean claim rate by 40-50%; vague diagnosis codes trigger automatic medical review
Do not bill 74290 with same-day abdominal ultrasound without modifier 59 and clear documentation of distinct clinical indication
Impact: Prevents NCCI bundling edit denials; unmodified claims will auto-deny approximately $80.87 per occurrence

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74290 in 2025?

The 2025 Medicare national average reimbursement for CPT 74290 is $80.87 for both facility and non-facility settings. This is based on 2.5 total RVUs (0.32 work RVU, 2.15 PE RVU, 0.03 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Is CPT 74290 still covered by Medicare in 2025?

CPT 74290 remains a valid code in 2025, but coverage varies by Medicare Administrative Contractor (MAC) and clinical indication. Many MACs have restrictive Local Coverage Determinations (LCDs) favoring ultrasound as first-line imaging, requiring strong medical necessity documentation when cholecystography is performed instead of or in addition to ultrasound.

What is the difference between CPT 74290 and 76705?

CPT 74290 is a contrast x-ray examination of the gallbladder (cholecystography), while CPT 76705 is an ultrasound of the abdomen including gallbladder. Ultrasound (76705) has become the first-line imaging modality for gallbladder evaluation due to lower cost, no radiation, and no contrast requirement. 74290 is now used primarily for functional assessment when ultrasound is inconclusive.

Can CPT 74290 be billed with an abdominal ultrasound on the same day?

Yes, but requires modifier 59 and clear documentation of distinct clinical purposes. NCCI edits may bundle these services, so documentation must show that the cholecystography provided unique diagnostic information not obtainable from ultrasound alone, or that they evaluated different clinical questions requiring both modalities.

What modifiers are commonly used with CPT 74290?

The most common modifiers for 74290 are modifier 26 (professional component only) and TC (technical component only) when splitting billing between physician interpretation and facility technical services. Modifier 59 is used to indicate distinct procedural service when performed with other imaging, and modifier 76 for repeat procedures on the same day.

What diagnosis codes support medical necessity for CPT 74290?

Diagnosis codes that support 74290 include K80.20 (calculus of gallbladder without cholecystitis), K81.9 (cholecystitis unspecified), K82.8 (other specified diseases of gallbladder including functional disorders), and K82.9 (disease of gallbladder, unspecified). Functional gallbladder disorders requiring contractility assessment provide the strongest justification over ultrasound.

How many RVUs is CPT code 74290 worth in 2025?

CPT 74290 has 2.5 total RVUs in 2025, consisting of 0.32 work RVUs, 2.15 practice expense RVUs (both facility and non-facility), and 0.03 malpractice RVUs. The work RVU reflects the relatively low physician effort for image interpretation compared to interventional procedures.