Summary & Overview
CPT 74742: Fallopian Tube Catheterization for Diagnosis or Reestablishing Patency
CPT code 74742 represents physician-performed catheterization of a fallopian tube to diagnose blockages or restore patency. This procedure is clinically important in the evaluation and management of tubal-factor infertility and can influence subsequent reproductive care pathways. Nationally, it is performed in outpatient surgical centers and hospital outpatient departments and has implications for fertility treatment planning and resource utilization.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides an overview of clinical context, coding guidance, common modifiers, and what payers commonly cover for this type of service. Readers will find benchmarks and policy-relevant summaries that clarify how 74742 fits into procedural coding for gynecologic interventions, as well as considerations for claims processing and site-of-service differences.
This summary is intended for clinicians, billing professionals, and policy analysts who need a concise reference to the clinical purpose of CPT code 74742, the typical care settings where it is performed, and the payer landscape relevant to the procedure. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 74742 describes a procedure in which a physician catheterizes a fallopian tube to diagnose any blockages or to reestablish patency. This service is an interventional gynecologic procedure typically performed to evaluate or treat tubal occlusion as part of infertility assessment or management.
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Service type: Interventional gynecologic procedure for fallopian tube catheterization
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Typical site of service: Outpatient surgical center or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A typical patient is a reproductive-aged woman presenting for evaluation of infertility after 6–12 months of unsuccessful attempts to conceive. Prior imaging (hysterosalpingography or pelvic ultrasound) suggests possible fallopian tube occlusion or proximal tubal block. The gynecologist schedules a diagnostic and potential therapeutic fallopian tube catheterization under fluoroscopic guidance. The procedure is performed in an outpatient radiology or ambulatory surgery setting or in an operating room if combined with laparoscopy. The patient undergoes local anesthesia with sedation or general anesthesia per provider and payer policy. A transcervical catheter is introduced into the uterine cavity and advanced into the ostium of the fallopian tube; contrast is injected under fluoroscopy to confirm patency. If a proximal obstruction is identified, catheter manipulation or microcatheter techniques are used to attempt to reestablish patency. Postprocedure monitoring occurs in recovery until stable for discharge. Documentation includes indication, consent, preprocedural imaging, anesthesia type, procedural steps (catheterization, contrast volumes, fluoroscopic time), findings (patent vs obstructed tube), any therapeutic maneuvers performed, complications, and discharge instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician interpretation/professional work is billed separately from technical services. |