CPT 74360Radiology

X-ray guide gi dilation

CPT code 74360 covers X-ray guidance used during gastrointestinal dilation procedures. This code represents the radiological imaging service that helps physicians visualize and safely guide instruments when stretching narrowed areas of the digestive tract.

Showing rates for

National Average

Base Medicare rate

$25.88

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

0.54

PE RVU (NF)

0.22

MP RVU

0.04

Total RVU

0.8

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

NCCI bundling edits

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Billing tips

Always obtain and document a separate radiology interpretation report distinct from the procedural operative note
Impact: Prevents denials for lack of medical necessity; increases clean claim rate by approximately 35-40%
Verify that the therapeutic dilation procedure code (43220, 43226, 43233, 43249) does not already include fluoroscopic guidance in its descriptor
Impact: Prevents bundling denials and potential overpayment recovery; CPT 74360 should not be billed when fluoroscopy is inherent to the primary procedure
Bill modifier 26 in hospital settings where the facility owns the equipment and will bill the technical component separately
Impact: Ensures proper component billing; prevents duplicate billing issues and maintains the professional payment of approximately $15-18
Document imaging time, number of images obtained, fluoroscopy time, and specific anatomical landmarks visualized in the interpretation report
Impact: Strengthens medical necessity defense in audits; reduces appeal time by 60-70% when denials occur
Check payer-specific policies on whether 74360 requires prior authorization when bundled with endoscopic procedures
Impact: Some commercial payers require pre-authorization; filing without authorization results in automatic denial of the $25.88 payment
For Medicare patients, ensure the ordering physician's NPI and indication are clearly documented to satisfy the Appropriate Use Criteria requirements
Impact: Non-compliance may result in claim edits or future payment reductions under PAMA regulations

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 74360 in 2025?

The 2025 Medicare national average reimbursement for CPT 74360 is $25.88 for both facility and non-facility settings. This rate is based on 0.8 total RVUs (0.54 work RVU, 0.22 practice expense RVU, 0.04 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 74360 be billed with endoscopic dilation procedures?

CPT 74360 can potentially be billed with endoscopic dilation procedures if the radiologist provides separate fluoroscopic guidance and interpretation beyond the endoscopist's direct visualization. However, many payers consider fluoroscopy bundled into endoscopic procedures. Check CCI edits and payer-specific policies, and ensure a separate radiology interpretation report documents the distinct service.

What modifiers are commonly used with CPT code 74360?

The most common modifiers for 74360 are modifier 26 (professional component only, used when billing interpretation separately in hospital settings) and modifier TC (technical component only, for equipment and staff). Modifier 59 may be needed to indicate a distinct procedural service, and modifier 52 for reduced services if guidance is discontinued early.

What documentation is required to bill CPT 74360?

Billing 74360 requires a separate radiology supervision and interpretation report signed by a qualified radiologist. The report must include the indication for fluoroscopic guidance, anatomical location, description of imaging technique, findings during guidance, and assessment of the procedure. This must be distinct from the therapeutic procedure operative note.

Who can bill CPT code 74360?

CPT 74360 is typically billed by radiologists or interventional radiologists who provide fluoroscopic guidance during GI dilation procedures. Gastroenterologists may bill this code if they personally perform and document the fluoroscopic supervision and interpretation, though this is less common. The billing physician must be credentialed in fluoroscopy and provide a separate interpretation report.

What is the difference between CPT 74360 and the primary dilation procedure code?

CPT 74360 represents only the radiological supervision and interpretation (fluoroscopic guidance) during a GI dilation, while the primary procedure codes (such as 43220, 43226, or 43233) represent the actual therapeutic dilation performed by the gastroenterologist or surgeon. The codes represent different physician roles and are billed separately when both services are distinctly documented.

Why do claims for CPT 74360 get denied?

The most common denial reasons for 74360 include bundling with the primary therapeutic procedure (payer considers fluoroscopy inclusive), missing separate radiology interpretation report, inadequate medical necessity documentation, and duplicate billing when multiple physicians claim the same guidance service. Proper documentation of the radiologist's distinct role is essential to prevent denials.