Summary & Overview
CPT 74177: CT Scan of Abdomen and Pelvis with and without Contrast
CPT code 74177 is a critical diagnostic tool in radiology, representing a computed tomography (CT) scan of the abdomen and pelvis performed both without and with contrast material. This procedure is widely used to evaluate patients with abdominal pain, suspected obstructions, kidney stones, malignancies, and acute appendicitis, among other conditions. Its comprehensive imaging capabilities make it a cornerstone in the assessment and management of complex abdominal and pelvic cases across the United States.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, provide coverage for this service, reflecting its clinical importance and broad utilization. The procedure is typically performed in hospital outpatient departments or office-based radiology practices, ensuring accessibility for a wide patient population.
This publication offers an in-depth overview of 74177, including clinical indications, relevant ICD-10 diagnoses, common billing modifiers, and related CPT codes. Readers will gain insight into payer coverage, coding nuances, and the procedure's role in diagnostic radiology. The analysis also highlights policy updates and benchmarks relevant to medical billing and reimbursement, supporting stakeholders in understanding the evolving landscape of CT imaging services.
CPT Code Overview
CPT code 74177 represents a computed tomography (CT) scan of the abdomen and pelvis performed without contrast material, followed by contrast material(s), and further sections both with and without contrast. This procedure is classified under Diagnostic Radiology / Computed Tomography and is commonly performed in a hospital outpatient setting (POS 22) or an office setting (POS 11). The scan provides detailed imaging to assist in diagnosing a range of abdominal and pelvic conditions, supporting clinical decision-making for patients presenting with complex symptoms.
Clinical & Coding Specifications
Clinical Context
A patient presents to the hospital outpatient department or physician office with symptoms such as abdominal pain, suspected intestinal obstruction, or possible kidney stones. The clinician orders a computed tomography (CT) scan of the abdomen and pelvis to evaluate the underlying cause. The procedure involves an initial scan without contrast, followed by administration of contrast material, and then further imaging both with and without contrast. This workflow allows for comprehensive assessment of abdominal and pelvic structures, aiding in diagnosis of conditions like appendicitis, malignancy, or urinary calculi.
Coding Specifications
-
Modifier
26: Indicates the professional component of the service, used when the physician interprets the CT images but does not own the equipment. -
Modifier
TC: Indicates the technical component, used when billing for the use of the equipment and technical staff, but not the interpretation.
| Modifier Code | Description |
|---|---|
26 | Professional component |
TC | Technical component |
- Provider Taxonomy:
| Taxonomy Code | Specialty |
|---|---|
2085R0205X | Diagnostic Radiology |
Related Diagnoses
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R10.9: Unspecified abdominal pain- Relevant for patients presenting with abdominal pain where the cause is unclear, warranting CT imaging for diagnosis.
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K56.60: Unspecified intestinal obstruction- Used when there is suspicion of bowel obstruction, which CT can help confirm and localize.
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N20.0: Calculus of kidney- Indicates kidney stones, which are often evaluated with CT to assess size, location, and complications.
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C78.7: Secondary malignant neoplasm of liver and intrahepatic bile duct- Used for patients with known or suspected metastatic disease to the liver, where CT helps in staging and assessment.
-
K35.80: Unspecified acute appendicitis- Relevant for patients with suspected appendicitis, as CT is a key diagnostic tool to confirm inflammation and complications.
Related CPT Codes
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74176: CT abdomen and pelvis without contrast- Used when only non-contrast imaging is performed. Alternative to
74177when contrast is not indicated.
- Used when only non-contrast imaging is performed. Alternative to
-
74178: CT abdomen and pelvis without and with contrast- Used when both non-contrast and contrast imaging are performed, including additional sequences. May be used in similar clinical scenarios as
74177.
- Used when both non-contrast and contrast imaging are performed, including additional sequences. May be used in similar clinical scenarios as
-
72193: CT pelvis with contrast- Focuses solely on the pelvis with contrast. May be ordered separately if only pelvic pathology is suspected.
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74160: CT abdomen with contrast- Used for abdominal imaging with contrast only. May be combined with pelvic imaging if needed.
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71260: CT thorax with contrast- Used for thoracic imaging with contrast. May be performed in conjunction with abdominal/pelvic CT if thoracic pathology is suspected.
These codes are commonly used as alternatives or adjuncts to 74177 depending on the clinical indication and anatomical area of concern.
National Reimbursement Benchmarks
For CPT code 74177, the national mean rate for Medicare is $208.52, which is significantly lower than the BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, and Aetna) commercial average of $296.04. Commercial payers consistently reimburse at higher rates compared to Medicare, with UnitedHealth Group and Blue Cross Blue Shield both exceeding $320.00 on average.
Rate dispersion, measured as the difference between the 75th and 25th percentiles, varies across payers. Medicare shows the widest spread at $201.50, indicating substantial variability in rates. Cigna also exhibits a wide range of $199.67. In contrast, Aetna has the tightest range at $76.55, suggesting more consistent reimbursement levels. The table and chart below present the full breakdown of national benchmarks for each payer.
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