CPT 75574Radiology

Ct angio hrt w/3d image

CPT code 75574 covers a specialized CT scan of the heart that uses contrast dye and creates 3D computer images to visualize the heart's blood vessels and structure. This advanced imaging helps doctors diagnose coronary artery disease, heart defects, and other cardiac conditions without invasive procedures.

Showing rates for

National Average

Base Medicare rate

$318.29

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

2.4

PE RVU (NF)

7.28

MP RVU

0.16

Total RVU

9.84

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

NCCI bundling edits

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Billing tips

Always verify pre-authorization before scheduling; most commercial payers and Medicare Advantage plans require prior authorization for CPT 75574
Impact: Prevents 100% denial; pre-auth denials are the leading cause of non-payment for this code, potentially losing $318.29 per study
Document 3D post-processing work separately and explicitly in the radiology report; mention specific 3D reconstruction techniques, multiplanar reformats, and curved planar reformats used
Impact: Differentiates from basic cardiac CT (75571-75573) and supports medical necessity; inadequate 3D documentation can result in downcoding to lower-paying codes ($150-200 loss per case)
Ensure calcium scoring (75571) is not billed same day as 75574; these are bundled and calcium score is considered component of CTA
Impact: Prevents denial of the calcium score charge (typically $75-100) and avoids potential fraud flags for unbundling
Bill facility vs non-facility correctly based on actual site of service; both rates are identical at $318.29 for 2025, but incorrect POS codes trigger audits
Impact: Prevents claim rejection and audit triggers; while payment is same, incorrect POS reporting can delay payment 30-60 days
Link appropriate ICD-10 codes that support medical necessity: chest pain (R07.9), coronary artery disease screening (Z13.6), personal history of MI (Z86.74), or specific CAD codes (I25.x)
Impact: Improves first-pass acceptance rate by 25-40%; vague or unsupported diagnosis codes are second-leading denial reason
When billing split/shared between facility and professional, ensure both components use identical date of service and matching technical details to avoid coordination of benefits issues

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 75574 in 2025?

The 2025 Medicare national average reimbursement for CPT 75574 is $318.29 for both facility and non-facility settings. This rate is based on 9.84 total RVUs (2.4 work RVU, 7.28 PE RVU, 0.16 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Does CPT 75574 require prior authorization from Medicare or commercial insurance?

Original Medicare typically does not require prior authorization for 75574, but medical necessity must still be documented. However, Medicare Advantage plans and most commercial insurers do require prior authorization. Additionally, many payers require compliance with Appropriate Use Criteria (AUC) under the PAMA mandate. Always verify specific payer requirements before scheduling.

What is the difference between CPT 75574 and 75571 for cardiac CT?

CPT 75571 is a calcium scoring study without contrast that quantifies coronary calcification. CPT 75574 is a full CT angiography with intravenous contrast and 3D reconstruction that visualizes the coronary artery lumen and identifies stenosis. Code 75574 includes more extensive imaging and post-processing, reimburses higher, and the two codes should not be billed together on the same date of service.

Can I bill CPT 75574 with modifier 26 for professional component only?

Yes, modifier 26 should be appended when billing only the professional component (physician interpretation and report) without the technical component. This is common when a radiologist or cardiologist interprets a study performed at a separate facility. The professional component represents approximately 40-50% of the total allowable payment.

What diagnosis codes support medical necessity for CPT 75574?

Common supporting ICD-10 codes include: chest pain (R07.89, R07.9), coronary artery disease (I25.10), personal history of myocardial infarction (Z86.74), coronary atherosclerosis (I25.1x), evaluation of bypass grafts (Z95.1), and congenital cardiac anomalies (Q24.x). The diagnosis must demonstrate intermediate risk for CAD or specific anatomic questions that CTA can answer. Screening codes alone (Z13.6) typically will not satisfy medical necessity for most payers.

How often can CPT 75574 be billed for the same patient?

There is no specific Medicare frequency limitation for 75574, but medical necessity must be documented for each study. Most payers scrutinize repeat cardiac CTAs within 12-24 months unless there is documented change in clinical status, progression of symptoms, post-intervention follow-up, or new clinical indication. Routine surveillance without symptoms typically does not meet medical necessity criteria.

What are the RVU values for CPT code 75574 in 2025?

For 2025, CPT 75574 has a work RVU of 2.4, practice expense RVU of 7.28 (same for both facility and non-facility), and malpractice RVU of 0.16, for a total of 9.84 RVUs. When multiplied by the 2025 conversion factor of 32.3465, this yields the Medicare payment of $318.29.