Summary & Overview

CPT 74174: CT Angiography of Abdomen and Pelvis with Contrast

CPT code 74174 represents computed tomographic angiography (CTA) of the abdomen and pelvis with contrast, a high‑resolution vascular imaging study used to evaluate abdominal and pelvic arteries and veins. Nationally, this code is important for diagnosing vascular disease, planning surgical or endovascular interventions, and assessing trauma or acute abdominal vascular conditions. Payers commonly process claims for this service across commercial insurers and Medicare.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and the service context, payer coverage patterns, relevant billing modifiers, and common site‑of‑service considerations. The publication highlights benchmarking points and policy updates that affect authorization, bundling, and documentation expectations for advanced imaging.

This summary provides clinical context for when the study is used, the typical outpatient settings where the procedure occurs, and the operational elements that influence coding and billing. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 74174 describes a computed tomographic angiography (CTA) of the abdomen and pelvis with contrast. The procedure includes acquisition of contrast-enhanced CT images of the abdominal and pelvic vasculature and may include noncontrast images as part of the study. After image acquisition, a computerized process is used to reconstruct and select the most relevant views for interpretation.

Service type: Advanced diagnostic imaging (CT angiography)

Typical site of service: Hospital outpatient imaging center or independent radiology/imaging center, and may also be performed in an outpatient department of a hospital or an ambulatory surgical center depending on facility capabilities and patient needs.

Clinical & Coding Specifications

Clinical Context

A 64-year-old male with progressive abdominal pain, unexplained weight loss, and a history of peripheral arterial disease is referred from vascular surgery for diagnostic imaging. The clinician suspects mesenteric ischemia or an aortoiliac aneurysm involving the abdominal aorta and pelvic vasculature. The patient presents to the hospital radiology department or an outpatient imaging center for computed tomographic angiography (CTA) of the abdomen and pelvis with intravenous contrast. Typical workflow: the patient is screened for contrast allergy and renal function; IV access is obtained; noncontrast images may be acquired if evaluation for hemorrhage or calcified plaque is needed; contrast-enhanced arterial-phase CTA of the abdomen and pelvis is performed; thin-slice images are reconstructed and the technologist and radiologist use post-processing (including 3D and maximum intensity projection techniques) to select optimal views for interpretation. The radiologist documents findings such as arterial stenosis, occlusion, aneurysm, dissection, or vascular malformation and provides a diagnostic report to the referring clinician for treatment planning.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing physician interpretation only (technical component billed separately).
`TC`	Technical component	Use when billing imaging acquisition only (facility supplies equipment/staff).
`59`	Distinct procedural service	Use to indicate a separate, unrelated imaging service on the same day when documentation supports separate anatomic area or separate encounter.
`52`	Reduced services	Use when CTA is partially reduced or not completed due to patient factors (e.g., truncated exam).
`53`	Discontinued procedure	Use when procedure is started but halted for patient safety (e.g., contrast reaction, instability).
`76`	Repeat procedure by same physician	Use when the same provider repeats the CTA during the same session for clinical reasons.
`77`	Repeat procedure by another physician	Use when another provider repeats the CTA during the same session.
`91`	Repeat clinical diagnostic laboratory test	Occasionally used when repeat contrast-related labs are required; generally not typical for imaging but may apply to associated laboratory repeats.
`22`	Increased procedural services	Use when the work required is substantially greater than typical for CTA (rare; must be documented).
`25`	Significant, separately identifiable E/M service on same day	Use when a separate evaluation and management by the ordering or interpreting physician is performed on the same day as the CTA.
`50`	Bilateral procedure	Rarely applicable; use when bilateral technical designation is required for paired structures in reporting context.
`59`	Distinct procedural service	(Listed again per clinical relevance for clarifying unrelated procedures same day).
`XU`	Unusual non-overlapping service	Use to indicate that the CTA provided a distinct service not overlapping with other imaging when payer requires X{EPS} modifiers.
`Q0`	Investigational clinical service furnished under a clinical research study	Use when CTA performed as part of qualifying clinical research protocol.

Taxonomy Code	Specialty	Notes
`2084P0800X`	Diagnostic Radiology	Most common specialty performing CTA interpretation and image post-processing.
`2084P0202X`	Vascular & Interventional Radiology	Frequently performs and interprets vascular CTA, especially when planning interventions.
`207RC0000X`	Internal Medicine (Hospitalist)	Ordering clinicians who often request CTA for inpatients with acute abdominal vascular concerns.
`207RH0000X`	Emergency Medicine	Commonly orders CTA for acute presentations such as suspected mesenteric ischemia or trauma.
`207RP1001X`	Cardiology	May order abdominal/pelvic CTA when systemic arterial disease or aneurysm risk assessment is needed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K55.0`	Acute vascular disorders of intestine	CTA abdomen/pelvis evaluates mesenteric arterial occlusion or stenosis causing ischemia.
`I71.4`	Abdominal aortic aneurysm, without rupture	CTA is used to measure aneurysm size and assess extent into iliac vessels for surgical planning.
`I77.3`	Aneurysm of artery of lower extremity	Pelvic arterial imaging helps delineate aneurysm involvement of iliac or femoral segments.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	CTA can identify level and extent of arterial occlusion and collateral circulation.
`K57.20`	Diverticulosis of large intestine without perforation or abscess	When complicated by suspected bleeding or vascular involvement, CTA can localize active bleeding.
`R19.5`	Other fecal abnormalities	In the context of suspected ischemia or bleeding, CTA aids vascular assessment; included for clinical scenarios with abdominal findings.
`K35.80`	Unspecified acute appendicitis	Occasionally CTA is performed when differential includes vascular causes versus inflammatory causes with atypical presentations; used less commonly but relevant in complex cases.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`71275`	CT angiography, chest, with contrast, including non-contrast when performed; with contrast material(s) and further image post-processing	Chest CTA may be ordered in the same workup for suspected aortic pathology extending into the chest; complementary to abdominal/pelvic CTA for full aortic evaluation.
`74176`	Computed tomography, abdomen and pelvis; with contrast material, without non-contrast images	Alternative abdominal/pelvic CT protocol when only contrast-enhanced images are obtained; used when noncontrast images are not required.
`74177`	Computed tomography, abdomen and pelvis; without contrast material, followed by contrast material and further sequences	Used when a dedicated noncontrast series followed by contrast-enhanced acquisition is necessary for stone disease or hemorrhage assessment in addition to vascular evaluation.
`75557`	Computed tomography angiography, heart, with contrast, including image post-processing when performed	Cardiac CTA may be performed in patients with systemic atherosclerotic disease; included when comprehensive vascular assessment is required.
`74150`	Computed tomography, abdomen; without contrast material	Noncontrast abdominal CT often performed before contrast CTA if renal calculi or acute hemorrhage is suspected; may be part of the same imaging encounter.