CPT 74470Radiology

X-ray exam of kidney lesion

CPT code 74470 covers an X-ray examination performed to evaluate a specific lesion or abnormality in the kidney. This imaging procedure helps doctors visualize kidney masses, cysts, or other structural abnormalities using contrast material.

Showing rates for

National Average

Base Medicare rate

$24.26

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)

0.18

MP RVU

0.03

Total RVU

0.75

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

NCCI bundling edits

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Billing tips

Verify that documentation clearly identifies the specific lesion being evaluated and distinguishes this from a complete urogram (74400-74420)
Impact: Prevents downcoding or denial; improper code selection could result in $50-150 payment differential depending on alternative code
Document whether contrast material was administered and specify type and amount in the radiology report
Impact: Essential for medical necessity support; absence of contrast documentation can trigger automatic denials requiring costly appeals
Bill the global code (without modifiers) only when your facility owns the equipment and employs both the technologist and interpreting physician
Impact: Ensures full $24.26 reimbursement; incorrect global billing when only providing one component constitutes overbilling
Ensure the ordering physician's documentation supports medical necessity with specific indication beyond 'rule out kidney disease'
Impact: Vague indications trigger 15-25% denial rates; specific lesion characterization indication improves first-pass acceptance
When billing with modifier 26, verify the technical facility has billed or will bill the TC to avoid payment suspension
Impact: Split billing coordination errors cause 30-60 day payment delays and potential recoupment if both components aren't properly documented
Check for frequency limitations in your payer contracts; Medicare typically allows reasonable and necessary repeat studies but may question multiple studies within 90 days
Impact: Proactive ABN (Advanced Beneficiary Notice) collection when medical necessity may be questioned protects against $24.26 write-off per denied study

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74470 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 74470 is $24.26 for both facility and non-facility settings. This rate is based on 0.75 total RVUs multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 74470 and 74400?

CPT 74470 is a limited X-ray exam focused on evaluating a specific kidney lesion, while CPT 74400 represents a complete urography (intravenous pyelogram) that includes imaging of the entire urinary tract including kidneys, ureters, and bladder. Code 74400 is more comprehensive and has higher reimbursement.

Can CPT 74470 be billed with a kidney ultrasound on the same day?

Yes, CPT 74470 can be billed with kidney ultrasound (76770) on the same day if both studies are medically necessary and provide distinct diagnostic information. Documentation must support why both imaging modalities were required for complete lesion evaluation. Modifier 59 may be needed to indicate distinct procedural services.

How many RVUs is CPT code 74470 worth?

CPT 74470 has a total of 0.75 RVUs in 2025, consisting of 0.54 work RVUs, 0.18 practice expense RVUs (both facility and non-facility), and 0.03 malpractice RVUs according to the CMS Physician Fee Schedule.

Do I need prior authorization for CPT 74470?

Prior authorization requirements for CPT 74470 vary by payer and plan. Medicare typically does not require prior authorization for this code under traditional fee-for-service, but Medicare Advantage plans and commercial insurers may require it as part of radiology benefit management programs. Always verify with the specific payer before performing the service.

When should I use modifier 26 with CPT 74470?

Use modifier 26 with CPT 74470 when billing only for the professional component (physician interpretation and report) and the technical component (equipment, technologist, supplies) is performed and billed by a separate facility. This is common when radiologists interpret studies performed at hospitals or imaging centers they don't own.

Is CPT 74470 still commonly used or has it been replaced by CT imaging?

CPT 74470 is less commonly used today as CT and MRI have become preferred modalities for detailed kidney lesion characterization. However, it remains valid for specific clinical scenarios where plain radiography or fluoroscopy is sufficient, such as evaluating calcified lesions, assessing lesion stability in patients with contraindications to advanced imaging, or when ordered as follow-up imaging for previously characterized simple lesions.