Summary & Overview
CPT 74400: Intravenous Urography (Pyelography) for Kidneys, Ureters, Bladder
CPT code 74400 denotes an intravenous urography/pyelography exam that evaluates the kidneys, ureters, and bladder using contrast injected into a vein. This diagnostic radiology code remains relevant nationally for providers and payers managing imaging utilization for urinary tract evaluation, particularly when assessing hematuria, obstruction, or anatomic anomalies. The procedure is typically performed in hospital radiology departments, outpatient imaging centers, or ambulatory surgical centers.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and reimbursement policies for contrast urography vary by payer and care setting; understanding these differences is important for coding accuracy and claims processing. Common clinical alternatives and imaging pathways may affect utilization and prior authorization requirements.
Readers will find a concise explanation of what CPT code 74400 covers, the typical clinical indications and sites of service, and the payer landscape relevant to national billing and coverage. The publication also outlines benchmarks and policy considerations where available, highlights coding and documentation implications, and directs readers to related imaging codes and clinical guidance. Data not provided in the input are noted as unavailable.
Billing Code Overview
CPT code 74400 describes a diagnostic imaging examination of the kidneys, ureters, and bladder performed using intravenous contrast. The procedure is commonly called an intravenous urography or intravenous pyelography and may be performed with or without a KUB (kidneys, ureters, bladder) radiograph and tomography as part of the evaluation.
Service Type: Diagnostic radiology — contrast urography
Typical Site of Service: Hospital radiology department, outpatient imaging center, or ambulatory surgical center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old male presents with flank pain, recurrent urinary tract infections, and microscopic hematuria. The urologist orders an intravenous urography (IVU)/intravenous pyelography (IVP) to evaluate the kidneys, ureters, and bladder for obstructing stones, strictures, masses, or congenital abnormalities. The patient arrives to the radiology suite fasting per facility protocol. An intravenous line is placed and baseline renal function (serum creatinine) is confirmed acceptable by the ordering clinician. The radiology technologist performs fluoroscopic imaging after intravenous administration of iodinated contrast, obtaining nephrogram, pyelogram, and delayed images; a supine KUB and limited tomography may be acquired as part of the study. The radiologist interprets the images, documents findings, and issues a report to the referring urologist. Typical sites of service include an outpatient radiology department, hospital radiology suite, or ambulatory imaging center. The service type is diagnostic radiology with contrast (urography/pyelography) targeted to the urinary tract.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician interpretation for the study while the facility bills technical component separately. |
TC |