Summary & Overview
CPT 74230: Videofluoroscopic Swallow Study
CPT code 74230 describes a videofluoroscopic swallow study (VFSS) using barium sulfate contrast and cineradiography or videoradiography to visualize and record a patient’s swallowing mechanism. This functional radiologic procedure is central to diagnosing dysphagia, aspiration risk, and guiding multidisciplinary management for patients with suspected or known swallowing disorders. Nationally, accurate coding of CPT code 74230 affects clinical care pathways, utilization measurement, and imaging service workflows.
Key payers commonly referenced for coverage and reimbursement comparisons include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the procedure’s clinical role, typical sites of service, and the common billing context. The publication summarizes benchmarks and payment considerations across major payers, clarifies coding intent and procedure components, and outlines clinical scenarios where 74230 is typically applied.
This briefing supports clinicians, coding professionals, and administrators by clarifying what CPT code 74230 represents, where it is performed, and the policy and billing issues most relevant to its use in national practice settings.
Billing Code Overview
CPT code 74230 documents a dynamic radiographic evaluation of swallowing using a barium sulfate contrast agent with cineradiography or videoradiography. The provider visualizes and records the patient’s swallowing pattern; scout neck films and delayed images may be obtained and are included when performed.
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Service type: Diagnostic radiologic procedure, functional swallowing study (videofluoroscopic swallow study)
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Typical site of service: Hospital radiology department, outpatient imaging center, or specialized swallowing clinic with fluoroscopy capabilities
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with progressive dysphagia and suspected oropharyngeal swallowing dysfunction is referred by his primary care physician to radiology for objective assessment of swallowing mechanics. The patient reports coughing with liquids, nasal regurgitation, and recent unexplained weight loss. A speech-language pathologist and radiologist coordinate care. On the day of service the patient is positioned in the fluoroscopy suite, administered measured boluses of barium sulfate in a variety of consistencies, and imaged using cineradiography/videoradiography to visualize oral, pharyngeal, and upper esophageal transit. Scout neck films and delayed images are obtained as clinically indicated and included in the study. The radiologist interprets dynamic swallow sequence images, documents physiologic abnormalities (e.g., aspiration, penetration, delayed swallow initiation, cricopharyngeal dysfunction), and provides recommendations for therapeutic strategies or further diagnostic testing. Typical documentation includes indication, contrast administered, bolus types and volumes, fluoroscopic findings, clinician performing the study, and time-stamped cine loops retained in the imaging archive.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the interpreting physician's service separate from technical facility components. |