Summary & Overview
CPT 74220: Fluoroscopic Esophagram with Barium Swallow
CPT code 74220 denotes a fluoroscopic esophagram performed with a barium sulfate swallow, capturing live fluoroscopic visualization and recorded digital images, often supplemented by scout chest radiographs and delayed views. This diagnostic imaging code is important nationally for the evaluation of dysphagia, suspected structural or motility disorders of the esophagus, and preoperative assessment in relevant clinical pathways. Payers commonly involved in coverage and reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, how the service is typically delivered (radiology or outpatient imaging settings), common billing considerations tied to imaging components, and how this code fits into care pathways for esophageal evaluation. The publication also summarizes benchmarking and policy-relevant points where available and identifies gaps where data are not provided. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 74220 describes a fluoroscopic examination of the esophagus performed while the patient swallows a barium sulfate compound. The provider visualizes the esophagus with live fluoroscopy and records digital images; scout chest radiographs and any delayed images, if performed, are used for additional evaluation.
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Service type: Diagnostic fluoroscopic esophagram with real-time imaging and recorded digital images
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Typical site of service: Radiology departments, hospital outpatient imaging centers, and freestanding imaging facilities
Clinical & Coding Specifications
Clinical Context
A typical patient is a 54-year-old female presenting with progressive dysphagia to solids and intermittent regurgitation. After history, physical exam, and initial evaluation by the gastroenterologist, the clinician orders a barium swallow (esophagram) to assess for structural abnormalities, motility disorders, or obstruction. The procedure is scheduled in an outpatient radiology suite or hospital radiology department. The patient ingests a barium sulfate preparation while the radiologist or fluoroscopy-trained provider uses real-time fluoroscopy to image swallowing dynamics and anatomy, acquiring scout chest radiographs and digitized cine and static images. Delayed images may be obtained to evaluate retained contrast. The radiology team documents patient consent, clinical indication, technique (including oral contrast type and volumes), fluoroscopy time, views obtained, and any complications such as aspiration. Images and a written report are transmitted to the referring gastroenterologist. Typical sites of service include outpatient radiology centers, hospital outpatient departments, and inpatient radiology when performed for hospitalized patients. CPT 74220 describes the professional and technical work of the esophagram with fluoroscopic observation and recorded images; facility billing may involve the technical component modifier TC when applicable and the interpreting physician may append modifier 26 for the professional component if billed separately.
Coding Specifications
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