Summary & Overview
CPT 74250: Single-Contrast Small Bowel Study with Barium
CPT code 74250 represents a single-contrast small bowel radiographic study in which barium is instilled through a tube advanced into the duodenum or small intestine, with sequential X‑ray exposures and an initial scout film when performed. This diagnostic fluoroscopic procedure is a standard tool for evaluating small intestinal pathology such as obstruction, strictures, or motility disorders and remains relevant for cases where cross-sectional imaging is insufficient or unavailable. Nationally, the code is important for radiology utilization, preauthorization workflows, and payment policy discussions tied to imaging appropriateness and site-of-service differences.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, plus interpretive guidance on where this code fits in imaging pathways. The publication also summarizes benchmarks and payer coverage patterns when available, highlights policy considerations affecting reimbursement and prior authorization, and provides operational points for radiology practices and billing teams. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 74250 describes single-contrast radiographic imaging of the small intestine performed after instillation of barium through a tube passed via the nose or mouth into the duodenum or small intestine. The service includes a scout film if performed and sequential X‑ray exposures following the contrast instillation.
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Service type: Diagnostic fluoroscopic and radiographic small bowel study with single-contrast barium instillation
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Typical site of service: Hospital radiology department or outpatient imaging center where fluoroscopic gastrointestinal studies are performed
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of chronic intermittent abdominal pain, unexplained weight loss, and suspected small bowel obstruction is referred from the emergency department to radiology for evaluation. The gastroenterologist requests evaluation of small-bowel transit and mucosal filling defects after prior inconclusive abdominal radiographs and CT. The radiology team schedules a fluoroscopic small-bowel follow-through with nasoduodenal tube placement for single-contrast barium infusion under fluoroscopic guidance.
The clinical workflow includes pre-procedure verification of indications and allergies, placement of a nasogastric or nasoduodenal tube with fluoroscopic confirmation of tip location in the duodenum or proximal jejunum, a scout abdominal radiograph if indicated, instillation of single-contrast barium via the tube, and sequential fluoroscopic X-ray exposures to document contrast progression through the small intestine. The procedure is performed in an outpatient radiology suite or hospital radiology department with monitoring for aspiration risk; images are archived and a radiology report is issued to the referring provider. CPT 74250 is coded for the service and may be accompanied by modifiers for professional/technical components, unusual services, or circumstances as appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |