What documentation does 74176 require?

- Order indicating the clinical question: renal stone, contrast contraindication, post-trauma rapid screen, suspected SBO, etc. - Interpretation report covering solid organs (liver, spleen, kidneys, pancreas, adrenals), bowel, mesentery, retroperitoneum, pelvic organs, bones, visible vasculature, and stone burden when applicable. - If renal stone protocol, document stone location, size, density (HU), and presence of hydronephrosis. - Comparison to prior imaging.

What are common 74176 billing pitfalls?

- Billing 74150 (CT abdomen wo) plus 72192 (CT pelvis wo) on the same date for the same patient. NEVER do this when 74176 captures both regions. Insurance edits will catch and deny one. - Billing 74176 plus 74177 on the same date. The without-and-with combined code is 74178; do not stack 74176 and 74177. - Failing to document HU and stone characteristics on the renal stone protocol study. The 74176 deliverable for stone disease must include Hounsfield density to distinguish uric acid vs calcium oxalate stones, which affects therapy.

How much does 74176 pay in 2026?

2026 work RVU for 74176 is 1.74. National Medicare non-facility allowable is approximately $203.08 at the 2026 conversion factor. Adjust for locality GPCI and your payer's contracted conversion factor for actual payment.

74176

RadiologyCMS status: A

Computed tomography of the abdomen and pelvis without contrast material. CMS 2026 global wRVU 1.74, total RVU approximately 6.08, Medicare global allowable approximately $203. The CT renal stone protocol code; replaces billing CT abdomen plus CT pelvis separately when both are acquired without contrast in the same encounter.

Radiology Hospitalist Outpatient IM GI Nephro

Work RVU

1.74

Practice RVU

4.21

Malpractice RVU

0.13

Total RVU

6.08

2026 Medicare payment

$203.08

National GPCI = 1.000 · Conversion factor $33.4009 · Non-facility

Model this code

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When to use it

Use 74176 when both abdomen and pelvis are imaged without IV contrast in the same encounter. The canonical indication is the renal stone protocol (CT KUB) for suspected nephrolithiasis. Other indications: assessment of contraindication to IV contrast (severe CKD without dialysis, prior anaphylactoid reaction), urgent post-trauma screening when contrast cannot be obtained, gas-pattern evaluation for SBO when contrast would interfere. 74177 (with contrast) is the workhorse for most other abdominal/pelvic indications; 74178 (without and with) is reserved for complex characterizations such as adrenal mass or post-treatment oncology.

Documentation checklist

✓Order indicating the clinical question: renal stone, contrast contraindication, post-trauma rapid screen, suspected SBO, etc.
✓Interpretation report covering solid organs (liver, spleen, kidneys, pancreas, adrenals), bowel, mesentery, retroperitoneum, pelvic organs, bones, visible vasculature, and stone burden when applicable.
✓If renal stone protocol, document stone location, size, density (HU), and presence of hydronephrosis.
✓Comparison to prior imaging.
✓Setting modifier and signed report.

Common pitfalls

!Billing 74150 (CT abdomen wo) plus 72192 (CT pelvis wo) on the same date for the same patient. NEVER do this when 74176 captures both regions. Insurance edits will catch and deny one.
!Billing 74176 plus 74177 on the same date. The without-and-with combined code is 74178; do not stack 74176 and 74177.
!Failing to document HU and stone characteristics on the renal stone protocol study. The 74176 deliverable for stone disease must include Hounsfield density to distinguish uric acid vs calcium oxalate stones, which affects therapy.
!Reading a 74176 acquired without bowel contrast and billing for the workup of inflammatory bowel disease. IBD characterization usually requires enterography (74177 with IV + oral contrast, modifier added) not the renal stone protocol.
!Confusion with 74174 (CTA abdomen and pelvis). The CTA is a separate vascular study requiring timed IV contrast bolus, with its own indications (aneurysm, dissection, ischemia, GI bleed).

Common modifiers

26TC

Common ICD-10 pairings

N20.0N13.30R10.0K56.609N17.9S39.81XA

Payer notes

Medicare covers 74176 for renal stone protocol and other no-contrast abdominal indications. Many commercial payers require prior authorization for outpatient abdominal CT; ED imaging is auto-approved post-care. Document the specific reason for no-contrast (renal stone, contrast allergy, AKI/CKD) — payers audit for whether contrast would have been preferable.