CPT 74420Radiology

Urography rtrgr +-kub

CPT code 74420 covers retrograde urography, an X-ray imaging procedure where contrast dye is injected backward through the urinary tract to visualize the ureters and kidneys. This may include a preliminary kidney-ureter-bladder (KUB) X-ray.

Showing rates for

National Average

Base Medicare rate

$75.69

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

0.52

PE RVU (NF)

1.79

MP RVU

0.03

Total RVU

2.34

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

NCCI bundling edits

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Billing tips

Verify whether the KUB film was actually performed and documented, as 74420 includes the KUB component
Impact: Prevents unbundling denials if KUB is separately billed; saves potential $20-30 in recoupment per claim
Confirm the contrast injection approach was retrograde (through catheter) versus antegrade to distinguish from code 74425
Impact: Incorrect code selection between 74420 and 74425 can result in claim denial requiring resubmission and payment delay of 30-60 days
When performed in conjunction with cystoscopy, ensure the cystoscopy is separately billable and append modifier 59 to 74420 if necessary
Impact: Proper modifier use prevents bundling denials and preserves the full $75.69 reimbursement
For hospital outpatient settings, verify whether billing globally or split-billing with modifier 26/TC based on facility arrangements
Impact: Incorrect component billing can result in overpayment recovery or underpayment of 40-60% of allowable amount
Document laterality clearly in the report even though bilateral is assumed; use RT/LT modifiers for unilateral procedures
Impact: Some payers require laterality modifiers for proper adjudication; prevents denials for incomplete information
Review payer-specific LCD/NCD policies regarding medical necessity for retrograde urography versus alternative imaging
Impact: Prevents denials for medical necessity; retrograde studies may require documentation of why IV urography or CT urography was insufficient

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74420 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 74420 is $75.69 for both facility and non-facility settings. This is based on a total RVU of 2.34 and the 2025 conversion factor of 32.3465.

What is the difference between CPT 74420 and 74400?

CPT 74420 is for retrograde urography where contrast is injected backward through the urinary tract via catheter, while 74400 is for intravenous urography where contrast is administered through an IV and excreted by the kidneys. The approach to contrast administration determines the correct code.

Can I bill CPT 74420 with a cystoscopy on the same day?

Yes, but you must append modifier 59 to CPT 74420 to indicate it is a distinct procedural service from the cystoscopy. Documentation must clearly show that the radiologic supervision and interpretation was a separate, identifiable service beyond the cystoscopy procedure itself.

Does CPT 74420 include the KUB X-ray?

Yes, CPT 74420 includes a KUB (kidney-ureter-bladder) X-ray when performed as part of the retrograde urography study. The descriptor specifically states 'with or without KUB,' so the KUB should not be separately billed if it is part of the urography examination.

What are the work RVUs for CPT code 74420?

CPT 74420 has a work RVU of 0.52, practice expense RVU of 1.79 (both facility and non-facility), and malpractice RVU of 0.03, for a total RVU of 2.34 in 2025.

Do I need modifier 26 or TC when billing 74420?

Use modifier 26 when billing only the professional component (physician interpretation), or modifier TC when billing only the technical component (equipment and staff). If the same entity provides both components, bill the global code without a modifier to receive the full $75.69 reimbursement.

What diagnosis codes support medical necessity for CPT 74420?

Common supporting diagnoses include ureteral calculus, hydronephrosis, hematuria of unknown origin, ureteral stricture, suspected ureteral obstruction, and evaluation of congenital urinary tract anomalies. Documentation should explain why retrograde approach was necessary versus less invasive imaging like CT urography.