CPT 74450Radiology

X-ray urethra/bladder

CPT code 74450 covers an X-ray examination of the urethra and bladder, typically performed using contrast material to visualize these structures and detect abnormalities like blockages, stones, or structural problems.

Showing rates for

National Average

Base Medicare rate

$14.88

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

0.33

PE RVU (NF)

0.12

MP RVU

0.01

Total RVU

0.46

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

NCCI bundling edits

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Billing tips

Split bill professional and technical components when radiologist and facility are separate entities
Impact: Ensures both parties receive appropriate reimbursement; prevents $14.88 payment disputes between providers and facilities
Document whether contrast material was actually administered and the route of administration
Impact: Medical necessity documentation prevents denials; contrast documentation supports code selection and can affect 15-20% of claim approvals
Verify prior authorization requirements before procedure, especially for non-Medicare payers
Impact: Prevents 100% payment denials; many commercial payers require pre-authorization for all non-emergent imaging studies
Bill 74450 separately from cystoscopy procedures when both are performed; use modifier 59 if necessary
Impact: Prevents bundling denials that could result in loss of the $14.88 reimbursement for the radiographic component
Link appropriate ICD-10 diagnosis codes that support medical necessity (N21.0 for bladder stones, R31.9 for hematuria, N13.6 for pyonephrosis)
Impact: Diagnosis code matching reduces denial rates by 30-40%; generic or unspecified codes trigger automated denials
For pediatric patients, ensure documentation includes parent/guardian consent and medical necessity justification for radiation exposure
Impact: Reduces audit risk and appeals; pediatric imaging faces higher scrutiny due to radiation safety concerns

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74450 in 2025?

The 2025 Medicare national average reimbursement for CPT 74450 is $14.88 for both facility and non-facility settings. This rate is based on 0.46 total RVUs (0.33 work RVU, 0.12 practice expense RVU, 0.01 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What does CPT code 74450 include?

CPT 74450 includes a complete radiographic examination of the urethra and urinary bladder with or without contrast material. The code covers the technical performance of the X-ray imaging, radiologist interpretation and report, and all associated imaging supervision. It typically represents a voiding cystourethrogram (VCUG) or retrograde urethrogram.

Can CPT 74450 be billed with a cystoscopy on the same day?

Yes, CPT 74450 can be billed separately from cystoscopy procedures when both are medically necessary and provide distinct diagnostic information. Append modifier 59 or XU to 74450 to indicate a distinct procedural service and ensure documentation clearly shows the separate clinical value of each procedure to prevent bundling denials.

What diagnosis codes support medical necessity for CPT 74450?

Common supporting diagnosis codes include N21.0 (calculus in bladder), R31.9 (hematuria), N13.6 (pyonephrosis), N35.9 (urethral stricture), N39.0 (urinary tract infection), Q64.3 (congenital urethral abnormalities), and N13.71 (vesicoureteral reflux with reflux nephropathy). The diagnosis must demonstrate clear clinical need for anatomical imaging of the lower urinary tract.

Do I need to use modifier 26 or TC for CPT 74450?

Use modifier 26 when billing only the professional component (radiologist interpretation) and modifier TC when billing only the technical component (equipment and technologist services). If the same entity owns both the equipment and employs the interpreting physician, bill 74450 without modifiers for the global service. Component billing is common when radiologists interpret images from external facilities.

How often can CPT 74450 be billed for the same patient?

There is no specific Medicare frequency limitation for CPT 74450, but medical necessity must be documented for each study. Repeat imaging within short timeframes (less than 30-90 days) typically requires strong justification such as post-operative monitoring, inadequate prior study, acute clinical change, or treatment response assessment. Commercial payers may have specific frequency edits.

What are the documentation requirements to avoid audits for CPT 74450?

Essential documentation includes a physician order with clinical indication, complete radiologist interpretation report with signature and date, confirmation of contrast use if administered, medical record notes supporting medical necessity, patient identification verification, radiation dose recording, and comparison to prior studies when available. Missing interpretation reports are the most common audit finding leading to payment recoupment.