CPT 74775Radiology

X-ray exam of perineum

CPT code 74775 covers an X-ray examination of the perineum, the area between the genitals and the anus. This imaging study helps diagnose injuries, infections, abscesses, or foreign bodies in this anatomical region.

Showing rates for

National Average

Base Medicare rate

$28.46

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

0.62

PE RVU (NF)

0.23

MP RVU

0.03

Total RVU

0.88

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

NCCI bundling edits

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Billing tips

Verify that perineal imaging is not bundled with other pelvic or abdominal X-ray studies performed on the same date
Impact: Prevents denials and reduces appeals; bundling violations result in $28.46 payment loss
Document the specific clinical indication for perineal X-ray rather than more common pelvic imaging, as this is a specialized study
Impact: Reduces medical necessity denials by 60-70%; ensures the $28.46 reimbursement is not rejected
When performed in facility settings, ensure proper split billing with modifier 26 or TC to avoid duplicate payments or underpayment
Impact: Professional component typically represents $11-14 of the $28.46 total; incorrect billing leads to overpayment recoupment
Confirm that the X-ray interpretation specifically addresses perineal anatomy and pathology, not just general pelvic findings
Impact: Specific documentation supports code selection and reduces downcoding to general pelvic X-rays with different reimbursement
For trauma cases, link to appropriate ICD-10 codes for perineal injury to establish medical necessity
Impact: Proper diagnosis coding reduces claim denials by 40-50% and supports the 0.88 RVU valuation
Understand that most payers consider 74775 a rare code; proactive attachment of clinical notes may expedite initial payment
Impact: Reduces payment delays from 45-60 days to 14-21 days by preventing automatic medical review holds

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 74775 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 74775 is $28.46 for both facility and non-facility settings. This rate is based on a total RVU of 0.88 multiplied by the 2025 conversion factor of 32.3465.

How many RVUs is CPT code 74775 worth?

CPT 74775 has a total RVU value of 0.88, consisting of 0.62 work RVU, 0.23 practice expense RVU (both facility and non-facility), and 0.03 malpractice RVU.

What is the difference between CPT 74775 and routine pelvic X-rays?

CPT 74775 specifically describes an X-ray examination of the perineum (the area between the genitals and anus), which is a distinct anatomical region. Routine pelvic X-rays (such as CPT 72170-72190) image the bony pelvis and hip structures, not the soft tissue perineal region. The codes are not interchangeable and require different clinical indications.

Can CPT 74775 be billed with modifier 26 for professional component only?

Yes, CPT 74775 can be billed with modifier 26 when only the professional component (interpretation and report) is provided, such as when a radiologist interprets images taken at a hospital. The technical component would be billed separately by the facility using modifier TC.

What diagnosis codes support medical necessity for CPT 74775?

Common supporting ICD-10 codes include perineal trauma (S31.8), perineal abscess (L02.215), foreign body in perineum (T19.8), post-procedural complications of perineal procedures, and congenital anomalies affecting the perineal region. Specific diagnosis coding should match the clinical indication documented in the order.

Is prior authorization required for CPT 74775?

Prior authorization requirements vary by payer and region. Most Medicare Administrative Contractors do not require prior authorization for 74775 due to its low reimbursement, but some commercial payers may require authorization as part of general radiology management programs. Always verify with the specific payer before performing the study.

How often is CPT 74775 typically billed compared to other X-ray codes?

CPT 74775 is considered a rarely used code, representing less than 0.1% of all radiographic procedures. Its infrequent use is due to the specialized nature of perineal imaging and the preference for CT or MRI for most perineal pathology. This rarity can sometimes trigger automated payer reviews, making thorough documentation essential.