Summary & Overview
CPT 74176: CT Scan of Abdomen and Pelvis Without Contrast
CPT code 74176 is a widely used billing code for computed tomography (CT) scans of the abdomen and pelvis performed without contrast material. This diagnostic imaging procedure is essential for evaluating a range of abdominal and pelvic conditions, including pain, suspected neoplasms, and urinary tract issues. The code is most frequently billed in outpatient hospital settings, reflecting its role in routine diagnostic workups and urgent care scenarios.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, provide coverage for this service, underscoring its clinical importance and broad accessibility. The publication offers a comprehensive overview of payer coverage, typical clinical indications, and relevant billing modifiers such as 26 for the professional component and TC for the technical component. Readers will gain insights into associated taxonomies, common ICD-10 diagnoses linked to this procedure, and related CPT codes that differentiate between contrast and non-contrast imaging.
This summary equips healthcare professionals, administrators, and policy analysts with the latest benchmarks, policy updates, and clinical context for CPT code 74176. It highlights the procedure's significance in diagnostic radiology and its impact on patient care pathways, reimbursement practices, and coding compliance across the national healthcare landscape.
CPT Code Overview
CPT code 74176 represents a computed tomography (CT) scan of the abdomen and pelvis performed without contrast material. This procedure is classified under Diagnostic Radiology (Diagnostic Imaging) Procedures of the Abdomen and is commonly utilized to evaluate abdominal and pelvic structures for a variety of clinical indications. The typical site of service for this procedure is the Outpatient Hospital (Place of Service 22), where patients receive imaging services without the need for hospital admission. This non-contrast CT scan is a critical diagnostic tool for identifying conditions such as abdominal pain, kidney stones, and other abnormalities within the abdomen and pelvis.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with abdominal pain and possible urinary or gastrointestinal symptoms. The clinician orders a computed tomography scan of the abdomen and pelvis without contrast (CPT 74176) to evaluate for conditions such as kidney stones, gallbladder calculi, colitis, or to assess for malignancy. The radiology team performs the scan, and the images are interpreted by a diagnostic radiologist. The procedure is typically performed in an outpatient setting, and the workflow involves image acquisition, interpretation, and reporting.
Coding Specifications
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Modifiers:
- Modifier
26: Used to indicate the professional component, meaning only the interpretation of the images is billed. - Modifier
TC: Used to indicate the technical component, meaning only the acquisition of the images is billed.
- Modifier
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Provider Taxonomies:
Taxonomy Code Specialty Name 2085R0202XDiagnostic Radiology 2085N0700XNuclear Radiology 2085B0100XBody Imaging
These taxonomies represent providers specializing in diagnostic imaging, nuclear radiology, and body imaging.
Related Diagnoses
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R10.9: Unspecified abdominal pain- Relevant for patients presenting with abdominal pain where the cause is unclear, warranting imaging to rule out various pathologies.
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K52.9: Noninfective gastroenteritis and colitis, unspecified- Used when evaluating patients with gastrointestinal symptoms such as diarrhea or abdominal discomfort, to assess for colitis or other inflammatory conditions.
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N20.0: Calculus of kidney- Indicates suspicion or confirmation of kidney stones, which can be visualized on CT imaging.
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K80.20: Calculus of gallbladder without cholecystitis- Used for patients suspected of having gallstones without associated inflammation, often evaluated by CT when ultrasound is inconclusive.
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C25.9: Malignant neoplasm of pancreas, unspecified- Relevant for patients with suspected or known pancreatic cancer, where CT imaging is used for diagnosis or staging.
Related CPT Codes
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74177: Computed tomography, abdomen and pelvis; with contrast material- Used when the CT scan is performed with contrast. This is an alternative to
74176when contrast is clinically indicated.
- Used when the CT scan is performed with contrast. This is an alternative to
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74175: Computed tomography, abdomen and pelvis; without contrast, followed by contrast and further sections- Used when the CT scan is performed first without contrast, then with contrast, and additional imaging is required. This code is used in workflows where both non-contrast and contrast images are needed for comprehensive evaluation.
These codes are alternatives or complements to 74176, depending on clinical requirements for contrast imaging.
National Reimbursement Benchmarks
National mean rates for CPT code 74176 show a clear gap between Medicare and commercial payers. Medicare's mean rate is $126.66, while the average for BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, and Aetna) is $190.24, representing a difference of $63.58. Commercial payers consistently reimburse at higher levels compared to Medicare.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Cigna exhibits the widest spread ($120.17), indicating greater variability in contracted rates. In contrast, Aetna has the tightest range ($60.33), suggesting more consistent reimbursement levels. Blue Cross Blue Shield, UnitedHealth Group, and BUCA also show substantial dispersion, while Medicare's range ($92.50) is moderate relative to commercial payers.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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