CPT 74283 Therapeutic Contrast Enema Reimbursement | OpenPayer

Summary & Overview

CPT 74283: Therapeutic Contrast Enema with Fluoroscopy

CPT code 74283 denotes a fluoroscopic therapeutic contrast enema used to visualize and relieve obstructions in the large intestine, including reduction of intussusception. Nationally, this procedure is important for emergent and urgent management of bowel obstruction in pediatric and adult populations when nonoperative decompression is indicated. It combines diagnostic imaging with a therapeutic maneuver under fluoroscopic guidance.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of billing and clinical context, typical sites of service (hospital outpatient or radiology suite), and the practical implications for coding and claims processing. The publication summarizes common modifiers associated with the service, delineates clinical scenarios where the procedure is used, and highlights benchmark considerations and policy implications relevant to national payers.

This summary provides clinicians, coders, and policy analysts with the clinical definition of the service, payer coverage scope, and the types of metrics and policy updates that inform reimbursement and utilization reviews. Data not available in the input is noted where applicable in supporting sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare74283CPTfluoroscopycontrast enemaintestinal obstructionintussusceptionradiologytherapeutic procedure

Billing Code Overview

CPT code 74283 describes a fluoroscopic procedure in which a provider injects air or contrast into the large intestine via an enema to visualize and relieve an intestinal obstruction. The technique uses a fluoroscope to watch the progression of the contrast or air and can flush out an obstruction or reduce an intussusception (a portion of the intestine that has folded in on itself).

Service type: Fluoroscopic contrast enema for therapeutic relief of large bowel obstruction or reduction of intussusception
Typical site of service: Hospital outpatient department or radiology suite where fluoroscopic procedures are performed

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents to the hospital with progressive abdominal distension, crampy abdominal pain, and obstipation for 24–48 hours. On exam the abdomen is distended with tympany and high-pitched bowel sounds; an abdominal radiograph suggests large-bowel obstruction with a transition point in the sigmoid colon. The patient is hemodynamically stable and cleared for fluoroscopic intervention. A gastroenterologist or interventional radiologist performs a contrast enema and air-contrast fluoroscopic study (CPT 74283) in a fluoroscopy suite or radiology department. Under fluoroscopic guidance, water-soluble contrast and air are instilled retrograde via an enema catheter to delineate the obstruction and attempt therapeutic decompression or reduction of an intussusception. The procedure can both diagnose the level and cause of obstruction (e.g., volvulus, mass, stricture) and may relieve a partial obstruction by unfolding a telescoped bowel segment or pushing through impacted stool.

Typical workflow:

Pre-procedure consent, review of allergies (contrast, latex), and focused history.
Bowel prep status and recent bowel activity confirmed; intravenous access obtained if sedation or contrast risk requires.
Patient positioned on fluoroscopy table, enema catheter placed, and test contrast administered with continuous fluoroscopic monitoring.
Real-time assessment of contrast passage, therapeutic maneuvers if indicated, and documentation of volume and type of contrast used.
Post-procedure observation for tolerance, monitoring for perforation signs, and written fluoroscopy report to the referring team.

Typical site of service: hospital radiology department or outpatient ambulatory imaging center with fluoroscopy capability.

CPT 74246: Upper GI Fluoroscopy with Air and High‑Density Barium

CPT-74328-ENDOSCOPIC-BILIARY-DUCT-FLUOROSCOPIC-S-AND-I

CPT 74328: Imaging Supervision and Interpretation for Endoscopic Biliary Duct Catheterization

CPT-74251-SMALL-BOWEL-DOUBLE-CONTRAST-ENTERIC-RADIOGRAPHY

CPT 74251: Small Bowel Double-Contrast Radiography

CPT-74300-INTRAOPERATIVE-CHOLANGIOGRAPHY-IMAGING-SUPERVISION-INTERPRETATION

CPT 74300: Intraoperative Cholangiography Imaging Supervision and Interpretation

CPT-74240-UPPER-GASTROINTESTINAL-SERIES-BARIUM-CONTRAST

CPT 74240: Upper Gastrointestinal Series with Barium Contrast

CPT-74235-ESOPHAGEAL-FOREIGN-BODY-REMOVAL-IMAGING-INTERPRETATION

CPT 74235: Imaging Supervision and Interpretation for Esophageal Foreign Body Removal

CPT-74301-INTRAOPERATIVE-BILIARY-CONTRAST-IMAGING-SANDI

CPT 74301: Intraoperative Biliary Contrast Imaging, S&I

CPT-74360-ESOPHAGEAL-BALLOON-DILATION-IMAGING-SUPERVISION-INTERPRETATION

CPT 74360: Imaging Supervision & Interpretation for Esophageal Balloon Dilation

CPT-74210-PHARYNX-CERVICAL-ESOPHAGUS-CONTRAST-STUDY

CPT 74210: Contrast Study of Pharynx and Cervical Esophagus

CPT-74340-DUODENAL-BALLOON-TUBE-IMAGING-SUPERVISION-INTERPRETATION

CPT 74340: Imaging Supervision and Interpretation for Duodenal Balloon-Tipped Tube

Showing 1–10 of 25

Coding Specifications

Modifier	Description	When to Use
`11`	Normal, established patient	Used when `CPT 74283` is billed for an established patient encounter without unusual circumstances.
`22`	Increased procedural services	Use when the procedure required substantially greater work than typical (extensive adhesiolysis maneuvers under fluoroscopy or prolonged therapeutic attempts).
`24`	Unrelated evaluation and management service by the same physician during a postoperative period	Not listed in provided modifiers; excluded.
`26`	Professional component	Use when billing only the interpreting physician’s professional component for the fluoroscopic interpretation.
`50`	Bilateral procedure	Generally not applicable to this procedure; included here as less commonly used modifier from the provided list when bilaterality billing guidance is relevant to paired organ procedures.
`52`	Reduced services	Use when the procedure was begun but discontinued or reduced (e.g., aborted due to patient discomfort or inability to advance catheter).
`53`	Discontinued procedure	Use when the procedure was terminated for patient safety prior to completion (e.g., suspected perforation or intolerance).
`59`	Distinct procedural service	Use when `CPT 74283` is performed on the same day as other imaging or therapeutic services and meets criteria for distinct service separation.
`76`	Repeat procedure by same physician	Use when the same provider repeats `CPT 74283` later the same day for medical necessity.
`77`	Repeat procedure by another physician	Use when a different provider repeats the procedure the same day.
`78`	Return to OR for a related procedure during global period	Use when the patient requires operative intervention related to the initial fluoroscopic procedure during the postoperative period.
`80`	Assistant at surgery	Rarely applicable; used if an assistant surgeon participates in an operative portion related to the case.
`81`	Minimum assistant surgeon	As above, rarely applicable.
`82`	Assistant surgeon (when a qualified resident is not available)	As above, rarely applicable.
`TC`	Technical component	Use when billing only the technical component (equipment, fluoroscopy suite, technologist) for `CPT 74283`.

Taxonomy Code	Specialty	Notes
`207RI0000X`	Radiology – Diagnostic Radiology	Radiologists commonly perform and interpret fluoroscopic contrast enemas.
`207RP1001X`	Radiology – Interventional Radiology	Interventional radiologists perform therapeutic fluoroscopic reductions and decompressions.
`208000000X`	Gastroenterology	Gastroenterologists may perform contrast enemas for diagnostic and therapeutic purposes in select settings.
`310400000X`	Surgery – General Surgery	General surgeons may perform or be involved when therapeutic fluoroscopic reduction is attempted prior to operative management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K56.6`	Other and unspecified intestinal obstruction	Common indication for `CPT 74283` to diagnose and attempt relief of a large-bowel obstruction.
`K59.0`	Constipation	Fecal impaction may be evaluated and occasionally relieved with a therapeutic contrast enema under fluoroscopy.
`K56.1`	Intussusception	Telecoping of the bowel can be diagnosed and often reduced with a therapeutic air-contrast or contrast enema.
`K57.30`	Diverticulosis of large intestine without perforation or abscess	Segmental large-bowel disease that can cause stricture or obstruction evaluated by contrast enema.
`K62.5`	Hemorrhage of anus and rectum	Not a primary indication but relevant when bleeding source must be considered; use cautiously if active bleeding is present.
`C18.9`	Malignant neoplasm of colon, unspecified	A colonic mass causing obstruction is a common reason for performing a contrast enema to delineate level and degree of luminal compromise.
`K57.20`	Diverticulitis of large intestine without perforation or abscess	In select subacute cases, contrast enema helps evaluate strictures or chronic complications contributing to obstruction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`74281`	Radiologic examination, lower GI tract; single contrast barium enema	Alternative diagnostic fluoroscopic study for evaluation of the large bowel when only single-contrast imaging is required; may be performed if air-contrast is not indicated.
`74282`	Radiologic examination, lower GI tract; double contrast barium enema	Related diagnostic study that provides enhanced mucosal detail; performed for non-acute evaluations when double-contrast technique is used instead of therapeutic enema.
`74284`	Radiologic examination, lower GI tract; infusion of contrast for enteroclysis/enterography (therapeutic OR diagnostic small bowel enema)	Performed when small-bowel contrast studies are needed or when pathology is suspected in the small intestine rather than the colon.
`74290`	Radiologic examination, contrast enema, with therapeutic intussusception reduction — pediatric	Pediatric-specific therapeutic code for fluoroscopic reduction of intussusception; clinically analogous when therapeutic reduction is performed in children, while `74283` is the adult air/contrast enema for obstruction reduction.
`76700`	Ultrasound, abdominal, limited	Often used adjunctively to assess for free fluid, guide management decisions, or evaluate alternative causes of abdominal pain before or after fluoroscopic intervention.

OpenPayer