Summary & Overview
CPT 74178: CT Abdomen and Pelvis, Without and With Contrast
CPT code 74178 represents a diagnostic computed tomography (CT) examination of the abdomen and pelvis performed first without contrast and then with contrast, including additional sections as needed. This combined non-contrast and contrast-enhanced CT is commonly used to evaluate acute abdominal or pelvic pain and to detect structural abnormalities of intra‑abdominal and pelvic organs. Nationally, the code is important for standardized reporting, appropriate imaging selection, and payer coverage determinations given its frequent use in emergency and outpatient settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for CPT code 74178, typical sites of service, and the service type. The publication summarizes common billing considerations and lists frequently used modifiers (input-provided), while providing benchmarks and policy-relevant notes where available. It also identifies missing input elements such as associated taxonomies and ICD-10 diagnoses when those data are not provided.
This piece is designed for clinicians, administrators, and billing professionals seeking a clear, national-level overview of the CPT code, how it is used clinically, and the payer landscape relevant to this combined CT abdomen and pelvis study.
Billing Code Overview
CPT code 74178 describes a computed tomography (CT) scan of the abdomen and pelvis performed first without intravenous contrast and then with intravenous contrast, including additional image sections as indicated. The study is performed to evaluate abdominal or pelvic pain and to assess abnormalities of internal organs such as the liver, spleen, pancreas, kidneys, bowel, and pelvic structures.
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Service type: Diagnostic imaging — combined non-contrast and contrast-enhanced CT of the abdomen and pelvis
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Typical site of service: Hospital outpatient radiology departments, outpatient imaging centers, and emergency department radiology suites
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 46-year-old adult presents to the emergency department with acute onset severe lower abdominal pain and nausea. The emergency physician orders a computed tomography scan of the abdomen and pelvis without intravenous contrast followed by images with intravenous contrast to evaluate for appendicitis, perforation, bowel obstruction, abscess, or other intra-abdominal pathology. The patient is screened for contraindications to iodinated contrast (renal function, allergy). The CT technologist performs the non-contrast acquisition first to identify calcifications, hemorrhage, or high-attenuation foreign material, followed by intravenous contrast-enhanced portal venous phase images of the abdomen and pelvis. The interpreting radiologist documents findings and impressions, provides urgent communication of critical results to the ED clinician, and generates a final report used for diagnosis and disposition (e.g., operative consultation, admission, or discharge). Typical sites of service include hospital radiology departments, emergency departments, and freestanding outpatient imaging centers equipped for CT with IV contrast administration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the interpreting radiologist's service separate from technical component |
TC |