Summary & Overview

CPT 74280: Double-Contrast Barium Enema of the Colon

CPT code 74280 represents a double-contrast barium enema of the colon — a radiologic diagnostic procedure that uses high-density barium and air to evaluate colonic mucosa. The study typically includes a scout film, post‑instillation abdominal X‑rays, and may involve intravenous glucagon to minimize bowel motion. This code remains relevant for differential diagnosis of colonic pathology when endoscopy or cross-sectional imaging are not indicated or as a complementary study.

Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes coverage patterns, billing considerations, and clinical context across these payers. It highlights how the service is typically billed in outpatient radiology settings and the procedural components that influence coding and documentation.

Readers will learn the clinical scope of CPT code 74280, typical sites of service, components included in the procedure, and common payer coverage categories. The report also outlines benchmarking and policy variations relevant to hospitals and imaging centers. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 74280barium enemaradiologydiagnostic imaginggastrointestinal imagingoutpatient imagingdouble-contrast

Billing Code Overview

CPT code 74280 describes a double-contrast barium enema study of the colon. The procedure involves infusion of high-density barium and air per rectum, followed by abdominal X‑ray exposures of the colon to visualize mucosal detail. A scout film and delayed image taken prior to contrast instillation are included when performed. Glucagon may be administered intravenously before the procedure to reduce bowel motility.

Service type: Radiologic diagnostic procedure — double-contrast barium enema
Typical site of service: Outpatient radiology department or hospital imaging center; can also be performed in ambulatory surgical centers or inpatient radiology suites

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with intermittent left lower quadrant abdominal pain, occasional rectal bleeding, and a history of altered bowel habits is referred for diagnostic evaluation. The gastroenterologist orders a double-contrast barium enema to evaluate for colonic pathology when colonoscopy is incomplete or contraindicated, or when radiographic detail of mucosal pattern is required. On the day of service the patient arrives to the radiology suite, receives brief pre-procedure evaluation including informed consent and bowel preparation confirmation, and an IV is placed for possible administration of glucagon to reduce colonic spasm. A scout abdominal radiograph is obtained, then high-density barium is instilled retrograde through the rectum followed by insufflation of air (double contrast). Multiple fluoroscopic and static abdominal X–rays are obtained, including delayed images as indicated. The study may be performed in an outpatient radiology center, hospital radiology department, or ambulatory surgery center depending on patient comorbidity and local resources. The imaging physician documents the scout image(s), contrast instillation technique, use of glucagon if given, number and views of abdominal exposures, and a final impression noting findings such as polyps, masses, diverticulosis, strictures, or mucosal irregularities.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the interpreting physician's professional services separate from technical imaging facility.
`TC`	Technical component	When billing only the facility/technical component of the radiographic study.
`52`	Reduced services	When the procedure was partially reduced or not completed but still performed to a limited extent.
`53`	Discontinued procedure	When the procedure was started but stopped for patient safety or other documented reasons.
`59`	Distinct procedural service	(Note: Not in provided list) Data not available in the input.
`76`	Repeat procedure by same physician	(Note: Not in provided list) Data not available in the input.
`73`	Discontinued outpatient hospital/ambulatory surgery center (before anesthesia)	When the procedure is canceled after patient preparation but before initiation of contrast/fluoroscopy.
`78`	Unplanned return to the operating/procedure room by same physician following the initial procedure for a related procedure during the postoperative period	When a repeat radiographic intervention is required due to a complication during the same episode.
`22`	Increased procedural services	When work or time substantially exceeds usual for the procedure (extensive technical difficulty or patient factors).
`23`	Unusual anesthesia	When general anesthesia is required and reported as an unusual circumstance for this diagnostic imaging.
`50`	Bilateral procedure	Not typically applicable to colonic imaging but used when procedures are bilateral; relevance limited for this study.
`59`	Data not available in the input.	Data not available in the input.

Taxonomy Code	Specialty	Notes
`2080P0700X`	Radiology (Diagnostic Radiology)	Primary specialty performing contrast barium enema studies and fluoroscopic interpretation.
`2085R0202X`	Gastroenterology	May request the exam and correlate findings; performs alternatives like colonoscopy.
`207RR0500X`	Emergency Medicine	May request emergent studies for acute abdominal symptoms in the ED setting.
`261QM1300X`	Surgery (Colon & Rectal Surgery)	Uses results for operative planning when surgical pathology is suspected.
`2086S0102X`	Nuclear Medicine	Provides adjunct imaging interpretation support in complex cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K57.30`	Diverticulosis of large intestine without perforation or abscess	Common indication to evaluate extent and complications such as strictures or chronic changes visible on barium enema.
`K63.5`	Polyp of colon	Barium enema can demonstrate filling defects suggestive of polyps when colonoscopy is incomplete.
`K50.90`	Crohn's disease, unspecified, without complications	Radiographic studies may show strictures or mucosal irregularity in inflammatory bowel disease.
`K51.90`	Ulcerative colitis, unspecified, without complications	Double-contrast studies can assess chronic mucosal changes when endoscopy is limited.
`R19.5`	Other fecal abnormalities	Indication for imaging when patients have unexplained changes in stool or obstruction symptoms.
`D12.6`	Benign neoplasm of colon, unspecified	Used when a mass is suspected and barium enema helps delineate lesion location and luminal effect.
`K62.5`	Hemorrhage of anus and rectum	Occult or intermittent rectal bleeding may prompt radiographic evaluation if endoscopy is non-diagnostic.
`K92.8`	Other specified diseases of the digestive system	Catch-all for non-specific indications prompting diagnostic barium enema.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`74270`	Radiologic examination, lower GI, single contrast barium enema; including rectal instillation and fluoroscopic supervision and interpretation	Alternative technique when single-contrast study is performed instead of double-contrast; may be billed if single contrast protocol used.
`74281`	Radiologic examination, colon, including barium enema; with endoscopic stent placement, or catheter placement (Note: actual descriptor may vary)	Not commonly billed with diagnostic `74280`; included here as a related fluoroscopic intervention code when contrast studies are combined with therapeutic catheter procedures.
`76000`	Fluoroscopic guidance for needle placement (separate or independent procedure)	May be used when additional fluoroscopic guidance is required for interventional sampling performed during the same session.
`70450`	CT head/brain without contrast (example cross-modality)	Represents unrelated imaging modality; may be performed in the same patient encounter for additional evaluation of symptoms.
`99213`	Office or other outpatient visit for evaluation and management	Pre- or post-procedure outpatient E/M for history, consent, and result discussion; commonly billed by requesting clinician.