CPT 74400Radiology

Urography iv +-kub tomog

CPT 74400 covers an intravenous urography (IVP), an X-ray imaging study where contrast dye is injected into a vein to visualize the kidneys, ureters, and bladder. This procedure may include a preliminary kidney-ureter-bladder (KUB) X-ray and tomography imaging.

Showing rates for

National Average

Base Medicare rate

$128.42

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

0.49

PE RVU (NF)

3.44

MP RVU

0.04

Total RVU

3.97

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

NCCI bundling edits

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Billing tips

Verify that tomographic views were actually performed before using 74400 instead of 74410 (IVP without tomography)
Impact: Incorrect code selection can trigger audit; 74410 reimburses differently and unbundling edits apply
Document exact volume and type of contrast media administered, along with radiologist supervision of injection
Impact: Missing contrast documentation is the #1 reason for denials; can result in 100% claim rejection ($128.42 loss)
Ensure all time-sequenced images are documented in the report (immediate, 5-minute, 15-minute, delayed views)
Impact: Incomplete image series may trigger downcoding to limited study (74420) reducing payment by approximately 30-40%
For split billing (professional/technical), verify both facility and physician use matching modifiers (26 and TC) to prevent duplicate payment issues
Impact: Modifier mismatch triggers automatic denials and recoupment actions; delays payment by 30-60 days
Check LCD/NCD policies for medical necessity indicators as many Medicare contractors now prefer CT urography over IVP
Impact: Failing to meet medical necessity criteria results in denial; include specific clinical indication in documentation
When billing same-day E/M services, ensure modifier 25 is appended to E/M code, not the radiology code, and document separate decision-making
Impact: Improper modifier placement causes E/M denial; represents additional $50-150 in lost revenue per encounter

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74400 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 74400 is $128.42 for both facility and non-facility settings. This is based on a total RVU of 3.97 multiplied by the 2025 conversion factor of 32.3465.

Does CPT 74400 include the preliminary KUB X-ray?

Yes, CPT 74400 is a comprehensive code that includes the preliminary KUB radiograph along with the intravenous urography and any tomographic views performed. You should not separately bill CPT 74018 or 74019 for the KUB when performing a complete IVP study under 74400.

What is the difference between CPT 74400 and 74410?

CPT 74400 includes tomographic imaging (special angled or layered views) in addition to the standard IVP images, while CPT 74410 is for IVP without tomography. Use 74400 only when tomographic views are actually performed and documented in the imaging report.

How do you bill CPT 74400 for professional component only?

To bill only the professional component (interpretation) for CPT 74400, append modifier 26 to the code. This is used when the physician provides only the interpretation and report while the technical component (equipment, technologist, supplies) is billed separately by the facility using modifier TC.

Is prior authorization required for CPT 74400?

Prior authorization requirements vary by payer. Many commercial insurers and Medicare Advantage plans now require prior authorization for IVP procedures due to preference for CT urography or ultrasound as first-line imaging. Always verify authorization requirements with the specific payer before scheduling.

Can you bill an E/M visit and CPT 74400 on the same day?

Yes, you can bill a separately identifiable E/M service on the same day as CPT 74400 by appending modifier 25 to the E/M code (not the radiology code). Documentation must clearly show the E/M service was significant, separately identifiable, and above and beyond the usual pre-procedure assessment.

What diagnosis codes support medical necessity for CPT 74400?

Common supporting diagnoses include hematuria (R31.x), urinary calculus (N20.x-N22.x), hydronephrosis (N13.x), recurrent UTI (N39.0), flank pain (M54.89), and suspected urinary obstruction. Always check your local Medicare contractor's LCD for specific coverage criteria, as many now limit IVP to cases where CT or ultrasound are contraindicated or inconclusive.