Summary & Overview
CPT 74261: CT Colonography Without Contrast
CPT code 74261 denotes a computed tomography (CT) examination of the colon performed without contrast, commonly called CT colonography without contrast. Nationally, this code captures a noninvasive imaging alternative for evaluating the large intestine when contrast administration is not used or contraindicated. It is relevant for radiology departments, outpatient imaging centers, and payers that cover diagnostic CT services.
Key payers in the scope of typical coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical context for CT colonography without contrast, typical sites of service, and the types of benchmarks and policy considerations often relevant to this service. The publication summarizes payer coverage patterns, utilization benchmarks where available, and recent policy drivers affecting diagnostic CT imaging reimbursement and authorization practices.
This report is intended to inform coding professionals, radiology administrators, and reimbursement analysts about the clinical purpose of CPT code 74261, payer coverage landscapes, and the operational implications for delivering CT colonography without contrast. Data not available in the input where specific benchmarking or detailed payer policy terms would otherwise appear.
Billing Code Overview
CPT code 74261 describes a computed tomography (CT) examination of the colon performed without the use of contrast. This service uses CT imaging technology to generate cross-sectional images of the large intestine for diagnostic evaluation.
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Service type: Diagnostic imaging (CT colonography without contrast)
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Typical site of service: Outpatient imaging center or hospital radiology department
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 58-year-old adult referred by gastroenterology for a noninvasive evaluation of the colon because of intermittent rectal bleeding, change in bowel habits, or inability to tolerate conventional colonoscopy. The CT colonography (virtual colonoscopy) is scheduled after standard bowel preparation and rectal insufflation with carbon dioxide or air. The patient arrives at an outpatient radiology imaging center or hospital outpatient CT suite; intravenous contrast is not administered for this study. A CT technologist positions the patient supine and prone as required, obtains thin-section helical CT images of the abdomen and pelvis focused on the colon, and reconstructs two- and three-dimensional images for polyp detection. A radiologist interprets the study, documents findings (polyps, masses, diverticulosis, colitis, or extracolonic incidental findings), and issues a report to the referring provider. Typical encounter duration includes preparation and scanning in an outpatient radiology department or imaging center with the interpreting provider being a diagnostic radiologist with abdominal imaging expertise.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the radiologist's interpretation separate from technical scanner services when the technical component is billed by another entity. |