CPT 74176 CT Abdomen/Pelvis Reimbursement | OpenPayer

Summary & Overview

CPT 74176: CT Scan of Abdomen and Pelvis Without Contrast

CPT code 74176 is a widely used billing code for computed tomography (CT) scans of the abdomen and pelvis performed without contrast material. This diagnostic imaging procedure is essential for evaluating a range of abdominal and pelvic conditions, including pain, suspected neoplasms, and urinary tract issues. The code is most frequently billed in outpatient hospital settings, reflecting its role in routine diagnostic workups and urgent care scenarios.

Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, provide coverage for this service, underscoring its clinical importance and broad accessibility. The publication offers a comprehensive overview of payer coverage, typical clinical indications, and relevant billing modifiers such as 26 for the professional component and TC for the technical component. Readers will gain insights into associated taxonomies, common ICD-10 diagnoses linked to this procedure, and related CPT codes that differentiate between contrast and non-contrast imaging.

This summary equips healthcare professionals, administrators, and policy analysts with the latest benchmarks, policy updates, and clinical context for CPT code 74176. It highlights the procedure's significance in diagnostic radiology and its impact on patient care pathways, reimbursement practices, and coding compliance across the national healthcare landscape.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 74176Diagnostic RadiologyComputed TomographyAbdomen and PelvisOutpatient HospitalMedical BillingImaging ProceduresClinical BenchmarkingPolicy UpdatesCoding Compliance

CPT Code Overview

CPT code 74176 represents a computed tomography (CT) scan of the abdomen and pelvis performed without contrast material. This procedure is classified under Diagnostic Radiology (Diagnostic Imaging) Procedures of the Abdomen and is commonly utilized to evaluate abdominal and pelvic structures for a variety of clinical indications. The typical site of service for this procedure is the Outpatient Hospital (Place of Service 22), where patients receive imaging services without the need for hospital admission. This non-contrast CT scan is a critical diagnostic tool for identifying conditions such as abdominal pain, kidney stones, and other abnormalities within the abdomen and pelvis.

Clinical & Coding Specifications

Clinical Context

A patient presents to the outpatient hospital with abdominal pain and possible urinary or gastrointestinal symptoms. The clinician orders a computed tomography scan of the abdomen and pelvis without contrast (CPT 74176) to evaluate for conditions such as kidney stones, gallbladder calculi, colitis, or to assess for malignancy. The radiology team performs the scan, and the images are interpreted by a diagnostic radiologist. The procedure is typically performed in an outpatient setting, and the workflow involves image acquisition, interpretation, and reporting.

Coding Specifications

Modifiers:
- Modifier 26: Used to indicate the professional component, meaning only the interpretation of the images is billed.
- Modifier TC: Used to indicate the technical component, meaning only the acquisition of the images is billed.
Provider Taxonomies:

Taxonomy Code Specialty Name

National Reimbursement Benchmarks

National mean rates for CPT code 74176 show a clear gap between Medicare and commercial payers. Medicare's mean rate is $126.66, while the average for BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, and Aetna) is $190.24, representing a difference of $63.58. Commercial payers consistently reimburse at higher levels compared to Medicare.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Cigna exhibits the widest spread ($120.17), indicating greater variability in contracted rates. In contrast, Aetna has the tightest range ($60.33), suggesting more consistent reimbursement levels. Blue Cross Blue Shield, UnitedHealth Group, and BUCA also show substantial dispersion, while Medicare's range ($92.50) is moderate relative to commercial payers.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

National Mean Rates for CPT Code `74176` by Payer

Related Codes

CPT-74018-SINGLE-ABDOMEN-XRAY-VIEW

CPT 74018: Single Abdominal Radiograph, One View

CPT-74183-ABDOMINAL-MRI-WITH-AND-WITHOUT-CONTRAST

CPT 74183: MRI of Abdomen Without and With Contrast

CPT-74170-CT-ABDOMEN-WITH-AND-WITHOUT-CONTRAST

CPT 74170: CT Abdomen Without and With Contrast

CPT-74150-CT-ABDOMEN-NON-CONTRAST

CPT 74150: CT Scan of Abdomen Without Contrast

74177-COMPUTED-TOMOGRAPHY-ABDOMEN-AND-PELVIS-WITHOUT-CONTRAST

CPT 74177: CT Scan of Abdomen and Pelvis with and without Contrast

CPT-74175-ABDOMINAL-CT-ANGIOGRAPHY-CONTRAST

CPT 74175: Abdominal CT Angiography with Contrast

CPT-74185-MRI-ANGIOGRAPHY-ABDOMEN

CPT 74185: MRI Angiography of Abdominal Blood Vessels

CPT-74160-CT-ABDOMEN-WITH-CONTRAST

CPT 74160: CT Scan of Abdomen with Intravenous Contrast

CPT-74182-MRI-ABDOMEN-WITH-CONTRAST

CPT 74182: MRI of Abdomen With Contrast

CPT-74178-CT-ABDOMEN-AND-PELVIS-W-AND-WO-CONTRAST

CPT 74178: CT Abdomen and Pelvis, Without and With Contrast

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Summary & Overview

CPT 74176: CT Scan of Abdomen and Pelvis Without Contrast

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

Related Codes