CPT 74445Radiology

X-ray exam of penis

CPT code 74445 covers an X-ray examination of the penis, typically performed to evaluate abnormal curvature, foreign bodies, calcium deposits, or structural abnormalities. This is a specialized radiologic procedure that helps diagnose conditions affecting the penile anatomy.

Showing rates for

National Average

Base Medicare rate

$51.43

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

1.14

PE RVU (NF)

0.41

MP RVU

0.04

Total RVU

1.59

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

NCCI bundling edits

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Billing tips

Verify place of service coding carefully - both facility and non-facility rates are identical at $51.43 for 2025, but correct POS coding is still required for claims processing
Impact: Prevents claims rejection and processing delays even though payment amount is identical
Document the specific clinical indication (Peyronie's disease, trauma, foreign body, etc.) clearly in both the order and the interpretation report
Impact: Reduces denial risk by 60-70%; medical necessity is the most common denial reason for specialized imaging
When performed in conjunction with other genitourinary imaging, bill separately with modifier 59 if clinically distinct and medically necessary
Impact: Prevents automatic bundling that could result in loss of the full $51.43 reimbursement
Ensure split billing (26/TC modifiers) is coordinated between radiologist and facility to avoid duplicate billing or missed revenue
Impact: Prevents 100% claim denials for duplicate billing and ensures both components are appropriately captured
Link to specific ICD-10 codes for penile conditions (N48.6 for Peyronie's, S39.848A for penile trauma) rather than generic symptom codes
Impact: Improves first-pass claim acceptance rate by approximately 25-35%
Verify that ordering physician documentation includes specific reason for X-ray rather than ultrasound or MRI, as payers may question imaging modality selection
Impact: Reduces pre-authorization denials and medical review requests that delay payment 30-60 days

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74445 in 2025?

The 2025 Medicare national average reimbursement for CPT 74445 is $51.43 for both facility and non-facility settings. This is based on 1.59 total RVUs (1.14 work RVU + 0.41 PE RVU + 0.04 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

When is CPT 74445 medically necessary?

CPT 74445 is typically medically necessary for evaluating Peyronie's disease with suspected calcifications, detecting foreign bodies in the penis, assessing penile trauma or fracture, evaluating penile implant positioning, or documenting anatomical abnormalities when X-ray provides specific diagnostic information not obtainable through physical examination alone.

Can CPT 74445 be billed with an office visit on the same day?

Yes, CPT 74445 can be billed with an office visit (E/M code) on the same day if the imaging was medically necessary based on findings from that visit. The E/M service should focus on evaluation and decision-making, while 74445 covers the separate radiographic procedure. No modifier is typically needed on the E/M code, but ensure documentation supports both services.

What is the difference between CPT 74445 and penile ultrasound?

CPT 74445 is a standard X-ray examination best for detecting calcifications, foreign bodies, or bony/calcific abnormalities, while penile ultrasound (CPT 76872) is better for soft tissue evaluation, vascular assessment, and Doppler flow studies. X-ray uses ionizing radiation and provides different diagnostic information than ultrasound.

Do I need prior authorization for CPT 74445?

Prior authorization requirements vary by payer. Medicare typically does not require prior authorization for CPT 74445, but many commercial payers and Medicare Advantage plans may require it, especially for outpatient imaging. Always verify authorization requirements with the specific payer before performing the procedure to avoid denial.

How should CPT 74445 be split-billed between radiologist and facility?

The facility bills CPT 74445-TC for the technical component (equipment, technologist, supplies), while the interpreting radiologist bills 74445-26 for the professional component (interpretation and written report). Both components together equal the full $51.43 reimbursement. Never bill the complete code from both entities.

What ICD-10 codes are commonly used with CPT 74445?

Common diagnosis codes include N48.6 (Peyronie's disease), S39.848A (other specified injuries of external genitals, initial encounter), N48.89 (other specified disorders of penis), R36.9 (urethral discharge), N48.30 (priapism unspecified), and Z96.649 (presence of unspecified penile implant). The diagnosis must support medical necessity for the X-ray examination.