Summary & Overview
CPT 74450: Retrograde Urethrocystography, Imaging Supervision & Interpretation
CPT code 74450 denotes the imaging supervision and interpretation of a retrograde urethrocystography, a fluoroscopic contrast study used to evaluate the bladder and lower urinary tract. Nationally, this code is important for documenting diagnostic radiology services that combine both technical and professional components for lower urinary tract imaging. Proper use of the code ensures clarity in billing when only the imaging supervision and interpretation are reported for the procedure.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national perspective on clinical context for the procedure, coding and billing considerations specific to reporting imaging supervision and interpretation only, and typical places of service where the procedure is performed. The summary highlights common modifiers used in practice (data provided separately) and notes where input data was not available.
This publication provides benchmarks and policy-relevant points for revenue cycle staff, radiology administrators, and clinical coders seeking to align documentation with billing practices. It also outlines what to look for in claims review and payer communications related to diagnostic fluoroscopic studies of the lower urinary tract.
Billing Code Overview
CPT code 74450 represents imaging supervision and interpretation for a retrograde urethrocystography procedure in which fluid is instilled in a retrograde fashion. The procedure is ordered to identify and diagnose abnormalities of the bladder and lower urinary tract. This code represents both the technical and professional components of the service and should be reported when only imaging supervision and interpretation are provided for the study.
Service Type: Diagnostic radiology — fluoroscopic contrast study of the lower urinary tract
Typical Site of Service: Hospital outpatient radiology department, outpatient imaging center, or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A middle-aged patient presents to the radiology suite with recurrent urinary tract infections, hematuria, and difficulty voiding. After urology evaluation and prior to surgical planning, the ordering provider requests a urethrocystography to evaluate urethral strictures, bladder contour abnormalities, or fistula. The patient is positioned in fluoroscopy, the bladder and urethra are filled retrograde with contrast under fluoroscopic guidance, and the radiologist performs imaging supervision and interpretation of the study, documents findings, and provides a report to the referring urologist. The procedure is typically scheduled as an outpatient radiology service in an ambulatory imaging center or hospital radiology department and may be performed under local anesthesia or topical lubricant; sedation is uncommon. The radiologist documents indications, technique (retrograde instillation of contrast), any complications, and imaging impressions used for diagnosis and treatment planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation/supervision separate from technical facility charges |
TC | Technical component |