Summary & Overview
CPT 74263: CT Colonography (Virtual Colonoscopy)
CPT code 74263 represents CT colonography, a noninvasive CT-based imaging exam that produces high-resolution 2D and 3D views of the colon for detection of colorectal polyps and cancer. The test is an alternative to conventional colonoscopy for colorectal cancer screening and diagnostic evaluation when endoscopic access is limited or as a patient-preference option. Nationally, CT colonography is relevant for population screening strategies, radiology service planning, and payer coverage policy given its role in colorectal cancer detection and its different resource profile compared with optical colonoscopy.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and the imaging service, common sites of service, and payer coverage context. The publication summarizes benchmarks and utilization patterns where available, highlights policy updates that affect access and reimbursement, and provides clinical context about when CPT code 74263 is typically used. Data limitations are noted where input information is incomplete. The goal is to give clinicians, administrators, and policy analysts a clear, national-level briefing on the code’s purpose, service setting, and payer considerations.
Billing Code Overview
CPT code 74263 describes a computed tomography (CT) colonography, a noninvasive imaging exam that acquires high–resolution two- and three–dimensional images of the colon to evaluate for colorectal polyps and cancer. Also referred to as virtual colonoscopy or virtual colonography, the service uses CT imaging and post-processing to visualize the colonic lumen and mucosal surface without conventional endoscopy.
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Service type: Diagnostic imaging study — CT colonography
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Typical site of service: Ambulatory imaging center or hospital outpatient radiology department
Clinical & Coding Specifications
Clinical Context
A 62-year-old average-risk adult presents for colorectal cancer screening and either cannot tolerate or declines optical colonoscopy. The provider orders a 74263 CT colonography (virtual colonoscopy) to noninvasively evaluate the colon for polyps or masses. The patient undergoes bowel preparation per radiology protocol, arrives at the outpatient imaging center or hospital radiology department, and is registered. The technologist reviews allergies and contraindications, obtains IV access if contrast is planned, and performs low‑dose CT acquisition with dedicated two- and three-dimensional reconstruction of the colon. The interpreting radiologist reviews axial and reformatted images to identify polyps, masses, or extracolonic findings, documents size and location of lesions, and issues a report with recommendations (for example, optical colonoscopy referral for polyps ≥6 mm). Typical sites of service are outpatient radiology departments, hospital-based radiology, and freestanding imaging centers. Common clinical workflow steps include pre-procedure screening, bowel prep verification, image acquisition, interpretation, and communication of results to the referring clinician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the interpreting radiologist's professional component separate from technical component |