Find policies, billing codes, payers, states, and providers

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.

Customize your policy alerts

Sign up for cpt 74220 policy alerts

Get alerted when payer policies referencing 74220 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

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.

Service type: Diagnostic fluoroscopic esophagram with real-time imaging and recorded digital images
Typical site of service: Radiology departments, hospital outpatient imaging centers, and freestanding imaging facilities

Find policies, billing codes, payers, states, and providers

CPT 74220: Fluoroscopic Esophagram with Barium Swallow

Customize your policy alerts

Sign up for cpt 74220 policy alerts

Get alerted when payer policies referencing 74220 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service type: Diagnostic fluoroscopic esophagram with real-time imaging and recorded digital images
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

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician interpretation of the esophagram separate from facility charge.
`TC`	Technical component	Use when billing only the facility’s equipment, supplies, and technologist portion of the procedure.
`52`	Reduced services	Use when the procedure is performed but reduced or partially completed (e.g., limited views obtained due to intolerance).
`53`	Discontinued procedure	Use when the procedure is started but terminated due to patient instability or aspiration risk.
`59`	Distinct procedural service	Use when a separate, unrelated procedure or service is performed on the same day requiring separate reporting.
`76`	Repeat procedure by same physician	Use when the same provider repeats the esophagram on the same day.
`77`	Repeat procedure by another physician	Use when a second provider repeats the procedure on the same day.
`TC`	Technical component	Use when only the imaging equipment and technologist services are billed by the facility.
`Q6`	Service furnished under a physician's supervision by a PA/NP	Use when a physician assistant or nurse practitioner performs the procedure under physician supervision as permitted by payer policy.
`QX`	Service performed by an assistant at surgery (rules vary)	Use when an appropriately credentialed assistant participates and payer accepts `QX` for assistant services, if applicable.
`52`	Reduced services	Use when contrast intake or image acquisition is curtailed due to patient intolerance.
`59`	Distinct procedural service	Use to indicate a separate imaging procedure unrelated to the esophagram on the same day.
`50`	Bilateral procedure	Rarely applicable; use only if a bilateral-specific circumstance is relevant per payer rules.
`22`	Increased procedural services	Use when complexity or time significantly exceeds typical levels (document justification).

Taxonomy Code	Specialty	Notes
208000000X	Diagnostic Radiology	Radiologists perform and interpret fluoroscopic esophagrams.
2086S0123X	Gastroenterology	Gastroenterologists commonly order the study and may be involved in interpretation of motility concerns.
363LP0808X	Radiology Assistant / Radiologic Technologist	Technologists perform fluoroscopic imaging and assist with contrast administration.
207Q00000X	Family Medicine	Primary care providers frequently refer patients for evaluation of dysphagia.
207L00000X	Internal Medicine	Hospitalists and internists may order inpatient esophagrams for acute dysphagia or aspiration concerns.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R13.10`	Dysphagia, unspecified	Primary indication for an esophagram to evaluate swallowing dysfunction.
`K22.2`	Esophageal diverticulum	Barium swallow commonly identifies diverticula such as Zenker or epiphrenic diverticula.
`K22.0`	Esophagitis	Imaging can show strictures or stasis associated with inflammation; helps correlate with symptoms.
`K22.8`	Other specified diseases of esophagus	Used for less common structural or motility abnormalities assessed with contrast study.
`K22.7`	Gastroesophageal reflux disease with esophagitis	Esophagram can demonstrate reflux, hiatus hernia, or complications related to GERD.
`C15.9`	Malignant neoplasm of esophagus, unspecified	Barium studies may show filling defects or obstruction prompting endoscopic evaluation and biopsy.
`R91.8`	Other nonspecific abnormal findings of chest imaging	Used when chest imaging suggests esophageal abnormality requiring targeted contrast study.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`71020`	Radiologic examination, chest; single view, frontal	May be obtained as a scout or adjunct chest radiograph prior to or after an esophagram to evaluate aspiration or thoracic pathology.
`74018`	Radiologic examination, abdomen; contrast, single or multiple views, diagnostic, esophagus/stomach/duodenum (barium) — note: (historical)	Sometimes historically referenced for upper GI series; modern practice distinguishes specific esophagram codes like `74220`.
`74240`	Radiologic examination, fluoroscopic observation and supervision of contrast reflux study of esophagus with video recording	Performed when concurrent or alternative fluoroscopic motility or reflux-focused studies are needed.
`43235`	Esophagogastroduodenoscopy, diagnostic, flexible, transoral; with biopsy	Frequently performed by gastroenterology after imaging identifies mucosal lesions or strictures requiring direct visualization or biopsy.
`43249`	Esophagogastroduodenoscopy with dilation of esophageal stricture (balloon or bougie)	Therapeutic procedure that may follow identification of a stricture on the esophagram.
`76140`	Radiology procedure, image documentation, localizing, limited study; 1 view	Used for radiographic localization or targeted imaging adjuncts during interventional procedures correlated with esophagram findings.

CPT 74210: Contrast Study of Pharynx and Cervical Esophagus

CPT-74221-DOUBLE-CONTRAST-ESOPHAGRAM-BARIUM-EFFERVESCENT

CPT 74221: Double‑Contrast Esophagram with High‑Density Barium

CPT-74230-VIDEOFLUOROSCOPIC-SWALLOW-STUDY

CPT 74230: Videofluoroscopic Swallow Study

CPT-74235-ESOPHAGEAL-FOREIGN-BODY-REMOVAL-IMAGING-INTERPRETATION

CPT 74235: Imaging Supervision and Interpretation for Esophageal Foreign Body Removal

CPT-74240-UPPER-GASTROINTESTINAL-SERIES-BARIUM-CONTRAST

CPT 74240: Upper Gastrointestinal Series with Barium Contrast

CPT-74246-UPPER-GI-DOUBLE-CONTRAST-FLUOROSCOPY

CPT 74246: Upper GI Fluoroscopy with Air and High‑Density Barium

CPT-74248-SMALL-INTESTINE-FOLLOW-THROUGH-AFTER-UPPER-GASTROINTESTINAL-STUDY

CPT 74248: Small Intestine Follow-Through After Upper GI Study

CPT-74250-SMALL-BOWEL-SINGLE-CONTRAST-BARIUM-STUDY

CPT 74250: Single-Contrast Small Bowel Study with Barium

CPT-74251-SMALL-BOWEL-DOUBLE-CONTRAST-ENTERIC-RADIOGRAPHY

CPT 74251: Small Bowel Double-Contrast Radiography

CPT-74261-CT-COLONOGRAPHY-NO-CONTRAST

CPT 74261: CT Colonography Without Contrast

Showing 1–10 of 25

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician interpretation of the esophagram separate from facility charge.
`TC`	Technical component	Use when billing only the facility’s equipment, supplies, and technologist portion of the procedure.
`52`	Reduced services	Use when the procedure is performed but reduced or partially completed (e.g., limited views obtained due to intolerance).
`53`	Discontinued procedure	Use when the procedure is started but terminated due to patient instability or aspiration risk.
`59`	Distinct procedural service	Use when a separate, unrelated procedure or service is performed on the same day requiring separate reporting.
`76`	Repeat procedure by same physician	Use when the same provider repeats the esophagram on the same day.
`77`	Repeat procedure by another physician	Use when a second provider repeats the procedure on the same day.
`TC`	Technical component	Use when only the imaging equipment and technologist services are billed by the facility.
`Q6`	Service furnished under a physician's supervision by a PA/NP	Use when a physician assistant or nurse practitioner performs the procedure under physician supervision as permitted by payer policy.
`QX`	Service performed by an assistant at surgery (rules vary)	Use when an appropriately credentialed assistant participates and payer accepts `QX` for assistant services, if applicable.
`52`	Reduced services	Use when contrast intake or image acquisition is curtailed due to patient intolerance.
`59`	Distinct procedural service	Use to indicate a separate imaging procedure unrelated to the esophagram on the same day.
`50`	Bilateral procedure	Rarely applicable; use only if a bilateral-specific circumstance is relevant per payer rules.
`22`	Increased procedural services	Use when complexity or time significantly exceeds typical levels (document justification).

Taxonomy Code	Specialty	Notes
208000000X	Diagnostic Radiology	Radiologists perform and interpret fluoroscopic esophagrams.
2086S0123X	Gastroenterology	Gastroenterologists commonly order the study and may be involved in interpretation of motility concerns.
363LP0808X	Radiology Assistant / Radiologic Technologist	Technologists perform fluoroscopic imaging and assist with contrast administration.
207Q00000X	Family Medicine	Primary care providers frequently refer patients for evaluation of dysphagia.
207L00000X	Internal Medicine	Hospitalists and internists may order inpatient esophagrams for acute dysphagia or aspiration concerns.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R13.10`	Dysphagia, unspecified	Primary indication for an esophagram to evaluate swallowing dysfunction.
`K22.2`	Esophageal diverticulum	Barium swallow commonly identifies diverticula such as Zenker or epiphrenic diverticula.
`K22.0`	Esophagitis	Imaging can show strictures or stasis associated with inflammation; helps correlate with symptoms.
`K22.8`	Other specified diseases of esophagus	Used for less common structural or motility abnormalities assessed with contrast study.
`K22.7`	Gastroesophageal reflux disease with esophagitis	Esophagram can demonstrate reflux, hiatus hernia, or complications related to GERD.
`C15.9`	Malignant neoplasm of esophagus, unspecified	Barium studies may show filling defects or obstruction prompting endoscopic evaluation and biopsy.
`R91.8`	Other nonspecific abnormal findings of chest imaging	Used when chest imaging suggests esophageal abnormality requiring targeted contrast study.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`71020`	Radiologic examination, chest; single view, frontal	May be obtained as a scout or adjunct chest radiograph prior to or after an esophagram to evaluate aspiration or thoracic pathology.
`74018`	Radiologic examination, abdomen; contrast, single or multiple views, diagnostic, esophagus/stomach/duodenum (barium) — note: (historical)	Sometimes historically referenced for upper GI series; modern practice distinguishes specific esophagram codes like `74220`.
`74240`	Radiologic examination, fluoroscopic observation and supervision of contrast reflux study of esophagus with video recording	Performed when concurrent or alternative fluoroscopic motility or reflux-focused studies are needed.
`43235`	Esophagogastroduodenoscopy, diagnostic, flexible, transoral; with biopsy	Frequently performed by gastroenterology after imaging identifies mucosal lesions or strictures requiring direct visualization or biopsy.
`43249`	Esophagogastroduodenoscopy with dilation of esophageal stricture (balloon or bougie)	Therapeutic procedure that may follow identification of a stricture on the esophagram.
`76140`	Radiology procedure, image documentation, localizing, limited study; 1 view	Used for radiographic localization or targeted imaging adjuncts during interventional procedures correlated with esophagram findings.

CPT 74210: Contrast Study of Pharynx and Cervical Esophagus

CPT-74221-DOUBLE-CONTRAST-ESOPHAGRAM-BARIUM-EFFERVESCENT

CPT 74221: Double‑Contrast Esophagram with High‑Density Barium

CPT-74230-VIDEOFLUOROSCOPIC-SWALLOW-STUDY

CPT 74230: Videofluoroscopic Swallow Study

CPT-74235-ESOPHAGEAL-FOREIGN-BODY-REMOVAL-IMAGING-INTERPRETATION

CPT 74235: Imaging Supervision and Interpretation for Esophageal Foreign Body Removal

CPT-74240-UPPER-GASTROINTESTINAL-SERIES-BARIUM-CONTRAST

CPT 74240: Upper Gastrointestinal Series with Barium Contrast

CPT-74246-UPPER-GI-DOUBLE-CONTRAST-FLUOROSCOPY

CPT 74246: Upper GI Fluoroscopy with Air and High‑Density Barium

CPT-74248-SMALL-INTESTINE-FOLLOW-THROUGH-AFTER-UPPER-GASTROINTESTINAL-STUDY

CPT 74248: Small Intestine Follow-Through After Upper GI Study

CPT-74250-SMALL-BOWEL-SINGLE-CONTRAST-BARIUM-STUDY

CPT 74250: Single-Contrast Small Bowel Study with Barium

CPT-74251-SMALL-BOWEL-DOUBLE-CONTRAST-ENTERIC-RADIOGRAPHY

CPT 74251: Small Bowel Double-Contrast Radiography

CPT-74261-CT-COLONOGRAPHY-NO-CONTRAST

CPT 74261: CT Colonography Without Contrast

Showing 1–10 of 25

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 74220: Fluoroscopic Esophagram with Barium Swallow

Sign up for cpt 74220 policy alerts

Billing Code Overview

Catch payer policy changes before they impact reimbursement

Catch payer policy changes before they impact reimbursement

OpenPayer

CPT 74220: Fluoroscopic Esophagram with Barium Swallow

Sign up for cpt 74220 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References