CPT 74742Radiology

X-ray fallopian tube

CPT code 74742 covers X-ray imaging of the fallopian tubes (hysterosalpingography or HSG), a diagnostic test where contrast dye is injected through the cervix and X-ray images are taken to check if the fallopian tubes are open or blocked.

Showing rates for

National Average

Base Medicare rate

$27.82

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

0.61

PE RVU (NF)

0.22

MP RVU

0.03

Total RVU

0.86

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

NCCI bundling edits

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Billing tips

Always bill 74742 separately from the injection procedure CPT 58340 (catheterization and introduction of saline or contrast for HSG). These are distinct services and should both be reported.
Impact: Bundling these codes results in loss of $27.82 reimbursement for the radiological component; proper separation can increase total procedure payment by 40-50%
Document the time of fluoroscopic supervision, number of images obtained, specific findings regarding tubal patency (bilateral spillage, unilateral blockage, proximal vs distal occlusion), and uterine cavity abnormalities in the formal radiological report
Impact: Inadequate documentation is the leading cause of audits for this code; comprehensive reporting reduces denial risk by approximately 65%
Verify pre-authorization requirements with commercial payers before scheduling, as many insurers require prior authorization for fertility-related procedures even though this is a diagnostic X-ray
Impact: Missing pre-authorization results in 100% payment denial from most commercial payers; affects approximately 30-40% of non-Medicare cases
Use diagnosis codes carefully: report infertility codes (N97.x) or specific indications like history of ectopic pregnancy (Z87.59) rather than non-specific codes like abnormal bleeding
Impact: Specific, medically appropriate diagnosis codes reduce medical necessity denials by 45%; vague coding triggers automatic reviews
When performed in hospital outpatient department, coordinate billing between professional and technical components to ensure modifier 26 is applied correctly to physician claims
Impact: Incorrect modifier use causes claim rejections requiring resubmission, delaying payment by 30-60 days and increasing administrative costs by $15-25 per claim correction

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74742 in 2025?

The 2025 Medicare national average reimbursement for CPT 74742 is $27.82 for both facility and non-facility settings. This rate is based on 0.86 total RVUs multiplied by the 2025 conversion factor of 32.3465. Local Medicare rates may vary by geographic location based on the GPCI (Geographic Practice Cost Index).

Does CPT 74742 include the contrast injection for hysterosalpingography?

No, CPT 74742 covers only the radiological supervision and interpretation of the HSG procedure. The actual injection of contrast material through the cervix is reported separately using CPT 58340 (catheterization and introduction of saline or contrast material for HSG). Both codes should be billed for a complete HSG procedure.

What modifiers are most commonly used with CPT 74742?

Modifier 26 (professional component) is most common when the radiologist bills only for interpretation while a facility bills for equipment and staff. Modifier TC (technical component) is used by facilities when an outside radiologist interprets. Modifier 52 (reduced service) applies when the procedure is incomplete due to patient factors or technical difficulties.

How many RVUs is CPT code 74742 worth in 2025?

CPT 74742 has 0.86 total RVUs in 2025, consisting of 0.61 work RVUs, 0.22 practice expense RVUs (both facility and non-facility), and 0.03 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Can CPT 74742 be billed bilaterally or with a bilateral modifier?

No, CPT 74742 should not be billed with bilateral modifiers (50, LT, RT) because hysterosalpingography inherently includes visualization of both fallopian tubes when present. The procedure code assumes bilateral examination, and the reimbursement reflects evaluation of both tubes. Bill the code once per procedure regardless of findings.

What diagnosis codes are typically used to support medical necessity for CPT 74742?

Common supporting diagnosis codes include N97.0-N97.9 (female infertility codes), N97.1 (female infertility of tubal origin), Z31.41 (encounter for fertility testing), Z87.59 (personal history of other complications of pregnancy including ectopic), and N70.93 (salpingitis and oophoritis, unspecified). The diagnosis must support the medical necessity of evaluating tubal patency.

Do I need prior authorization for CPT 74742 with commercial insurance?

Prior authorization requirements vary by payer but are frequently required for CPT 74742 because it is associated with fertility evaluation. Most commercial insurers classify this under fertility or reproductive services which commonly require pre-authorization. Always verify with the specific payer before scheduling, as performing without authorization typically results in denial even when medically necessary.