Summary & Overview
CPT 78740: Voiding Cystourethrogram for Ureteral Reflux Evaluation
CPT code 78740 identifies a fluoroscopic contrast study used to detect ureteral reflux by imaging the bladder and ureters during contrast injection. Nationally, this code represents an important diagnostic tool for evaluating suspected vesicoureteral reflux, recurrent urinary tract infections, or structural abnormalities affecting urine flow. Accurate coding for this study supports appropriate clinical follow-up and care coordination for both pediatric and adult patients.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common sites of service, and the types of operational considerations that affect billing and coverage for genitourinary fluoroscopic studies. The publication outlines typical benchmarks for utilization and reimbursement where available, summarizes relevant policy and billing nuances, and highlights documentation elements tied to procedural justification.
This briefing is intended to inform coding professionals, radiology departments, and payers about the clinical purpose and billing classification of CPT code 78740, operational settings where the service is delivered, and areas where payers commonly focus prior authorization and medical necessity review.
Billing Code Overview
CPT code 78740 describes a diagnostic imaging procedure to evaluate ureteral reflux by capturing fluoroscopic images of the bladder and ureters during injection of contrast material. This study assesses retrograde or vesicoureteral reflux and documents contrast flow from the bladder into one or both ureters.
Service type: Diagnostic radiology – genitourinary fluoroscopic study with contrast
Typical site of service: Hospital radiology department, outpatient imaging center, or inpatient radiology suite
Clinical & Coding Specifications
Clinical Context
A pediatric or adult patient presents with recurrent urinary tract infections, unexplained febrile episodes, hydronephrosis on ultrasound, or suspected vesicoureteral reflux. The patient is scheduled for a cystogram with retrograde contrast instillation to evaluate for ureteral reflux into one or both ureters and to document bladder anatomy and voiding dynamics. The procedure is typically performed in an outpatient radiology or pediatric radiology fluoroscopy suite, or in an ambulatory surgery center when sedation is required.
Workflow:
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Patient arrives with relevant history, prior imaging, and current urinalysis or urine culture results.
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Informed consent is obtained; sedation is planned if the patient is uncooperative (common in young children).
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A sterile catheter is inserted into the bladder; baseline fluoroscopic spot images may be obtained.
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Contrast is instilled while fluoroscopic imaging captures filling of the bladder and any reflux into the ureters and collecting systems; voiding images may be obtained if indicated.
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Images are archived and a radiologist documents findings including presence/grade of reflux, bladder contour, post-void residual, and any complications.
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The patient is monitored briefly post-procedure and discharged with follow-up instructions and communication to the referring clinician.