Summary & Overview
CPT 74290: Oral Cholecystography, Fluoroscopic Imaging of Gallbladder
CPT code 74290 denotes an oral cholecystography study: fluoroscopic X-ray imaging of the gallbladder and hepatobiliary system after oral ingestion of iodine-based contrast and dietary preparation. The test aids diagnosis of gallstones, masses, and other hepatobiliary abnormalities and remains relevant for selected diagnostic pathways where ultrasonography or other modalities are inconclusive. Nationally, billing and utilization of this diagnostic fluoroscopic study affect radiology service mix and resource planning in outpatient imaging centers and hospital radiology departments.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for use of the procedure, typical sites of service, common billing modifiers, and guidance on where to locate related code information. The publication summarizes benchmarks and policy-relevant considerations at a national level, clarifies the clinical indication and procedural workflow, and notes areas where input data was not provided. Data not available in the input is clearly identified so readers understand the scope and limits of the coverage presented.
Billing Code Overview
CPT code 74290 describes a radiologic procedure in which the provider uses fluoroscopic X-ray imaging to visualize the gallbladder and its contents after the patient follows a special preparatory diet and ingests an oral iodine-based contrast agent. The examination evaluates the liver and gallbladder for conditions such as gallstones and tumors.
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Service type: Diagnostic fluoroscopic imaging of the hepatobiliary system
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Typical site of service: Hospital radiology department or outpatient imaging center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45– to 70–year‑old adult referred for evaluation of suspected gallbladder disease after presenting with right upper quadrant abdominal pain, episodic biliary colic, nausea, or abnormal liver function tests. The ordering provider (usually a primary care physician, gastroenterologist, or general surgeon) requests a gallbladder fluoroscopic study to visualize gallbladder filling and emptying after the patient follows a pretest low‑fat diet and ingests oral iodine‑based contrast. The radiology department schedules the patient, confirms informed consent and allergy history (iodine/shellfish), and instructs on fasting and contrast ingestion timing. At the imaging visit a radiology technologist and radiologist perform the fluoroscopic exam using serial X‑ray imaging to assess gallbladder morphology, filling defects (stones), cystic duct patency, and biliary dynamics. Findings guide clinical management such as conservative therapy, cholecystectomy referral, or further biliary imaging (ultrasound, HIDA, MRCP) and are documented in the radiology report along with contrast used, patient tolerance, and any immediate complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the interpreting physician’s service separate from technical component. |
TC |