CPT 74355Radiology

X-ray guide intestinal tube

CPT code 74355 covers X-ray imaging guidance used to help place or reposition a feeding or drainage tube through the intestines. This involves real-time imaging while a physician advances the tube to the correct location.

Showing rates for

National Average

Base Medicare rate

$34.93

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

0.76

PE RVU (NF)

0.28

MP RVU

0.04

Total RVU

1.08

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

NCCI bundling edits

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Billing tips

Bill 74355 separately from the tube placement procedure itself - this code represents only the imaging guidance component
Impact: Prevents bundling denials and ensures full $34.93 reimbursement for guidance service
Document fluoroscopy time and saved images demonstrating tube advancement through pylorus and final position
Impact: Critical for medical necessity documentation; absence of saved images is primary audit trigger leading to recoupment
Verify placement service (43752, 44500) is billed by appropriate provider if performed by different physician
Impact: Prevents duplicate billing issues; 74355 should only represent radiologic guidance portion
Use modifier 26 in hospital settings where facility owns equipment unless employed physician with inclusive arrangement
Impact: Ensures correct component billing; improper global billing may result in 100% denial or overpayment recovery
Check LCD/NCD policies requiring ABN when performed for non-covered indications like elective tube exchange
Impact: Protects against patient balance billing complaints and compliance issues for non-covered services
For same-day repeat procedures, append modifier 76 with clear documentation of clinical necessity (tube malposition, dislodgement)
Impact: Enables additional $34.93 payment for medically necessary repeat guidance; improves acceptance rate from approximately 30% to 85% with proper documentation

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 74355 in 2025?

The 2025 Medicare national average reimbursement for CPT 74355 is $34.93 for both facility and non-facility settings, based on 1.08 total RVUs and the $32.3465 conversion factor.

Can CPT 74355 be billed with the tube placement procedure code?

Yes, CPT 74355 is separately reportable from tube placement codes like 43752 or 44500. The 74355 represents only the radiologic guidance component, while the placement code represents the actual insertion of the tube. Both require distinct documentation.

What modifier should be used when billing CPT 74355 in a hospital?

In hospital settings, physicians typically bill CPT 74355 with modifier 26 (professional component) for the interpretation only, while the facility bills the technical component (TC modifier) for equipment and staff. Employed physicians with inclusive contracts may bill globally without modifier.

How many RVUs is CPT code 74355 worth?

CPT 74355 has 1.08 total RVUs for 2025, consisting of 0.76 work RVUs, 0.28 practice expense RVUs, and 0.04 malpractice RVUs. Both facility and non-facility PE RVUs are identical at 0.28.

What documentation is required to bill CPT 74355?

Required documentation includes clinical indication for post-pyloric tube placement, fluoroscopy time or image count, documentation of tube passage through the pylorus, final position verification, saved representative images, and a separate physician interpretation report distinct from the tube placement procedure note.

Is CPT 74355 subject to the multiple procedure payment reduction?

No, CPT 74355 is a diagnostic radiology service and is not subject to MPPR for diagnostic imaging. However, it may be subject to bundling edits (NCCI) with certain tube placement procedures that require modifier 59 if separately identifiable.

What are common denial reasons for CPT 74355?

Common denials include bundling with tube placement procedure codes, lack of saved images or interpretation documentation, incorrect component billing (missing modifier 26 in hospital settings), and medical necessity denials when clinical indication for post-pyloric access is not clearly documented.