What documentation does 74177 require?

- Order with indication. The most defensible indications are: acute abdominal pain with peritoneal signs, suspected appendicitis or diverticulitis, post-operative complication, oncology staging or surveillance, GI bleed source identification, suspected abscess. - Verify contrast eligibility before scan: serum creatinine and eGFR (typically eGFR > 30 acceptable; 30 to 45 with hydration; under 30 contraindicated unless emergency), prior contrast reaction history, metformin use (hold for 48 hours post-contrast if eGFR is borderline). - Interpretation report covers solid organs, hollow viscera, mesentery, retroperitoneum, vascular structures with contrast phase, pelvic organs, lymph nodes, bones...

What are common 74177 billing pitfalls?

- Billing 74160 (CT abd w) plus 72193 (CT pelvis w) on the same date for the same patient. NEVER do this; 74177 is the correct single code. - Stacking 74176 and 74177 on the same date. The without-and-with combined code is 74178; choose that when both phases were obtained. - Performing 74177 without contrast safety review. Post-contrast AKI in a patient with undocumented eGFR is a malpractice and billing audit risk; document the contrast-safety verification.

How much does 74177 pay in 2026?

2026 work RVU for 74177 is 1.82. National Medicare non-facility allowable is approximately $239.15 at the 2026 conversion factor. Adjust for locality GPCI and your payer's contracted conversion factor for actual payment.

74177

RadiologyCMS status: A

Computed tomography of the abdomen and pelvis with IV contrast material. CMS 2026 global wRVU 1.82, total RVU approximately 7.16, Medicare global allowable approximately $239. The workhorse abdominal CT for most clinical indications; replaces billing CT abdomen plus CT pelvis separately when both are acquired with contrast.

Radiology Hospitalist Outpatient IM GI Heme/Onc

Work RVU

1.82

Practice RVU

5.20

Malpractice RVU

0.14

Total RVU

7.16

2026 Medicare payment

$239.15

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

Model this code

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When to use it

74177 is the first-line CT for abdominal pain, suspected appendicitis, diverticulitis, abscess, cholangitis, pancreatitis severity grading, oncology staging and surveillance, post-operative complications, and unexplained sepsis. The IV contrast highlights vascular structures, bowel-wall enhancement, and solid-organ pathology. 74176 (no contrast) is the alternative when contrast is contraindicated. 74178 (without and with) is reserved for adrenal mass characterization, complex cystic lesion evaluation, and selected oncology protocols. 74174 (CTA abdomen + pelvis) is a vascular study with timed bolus and a different indication set.

Documentation checklist

✓Order with indication. The most defensible indications are: acute abdominal pain with peritoneal signs, suspected appendicitis or diverticulitis, post-operative complication, oncology staging or surveillance, GI bleed source identification, suspected abscess.
✓Verify contrast eligibility before scan: serum creatinine and eGFR (typically eGFR > 30 acceptable; 30 to 45 with hydration; under 30 contraindicated unless emergency), prior contrast reaction history, metformin use (hold for 48 hours post-contrast if eGFR is borderline).
✓Interpretation report covers solid organs, hollow viscera, mesentery, retroperitoneum, vascular structures with contrast phase, pelvic organs, lymph nodes, bones, and any incidental findings.
✓For oncology surveillance, document RECIST measurements or response-assessment criteria as appropriate.
✓Setting modifier and signed report; comparison to prior CT when available.

Common pitfalls

!Billing 74160 (CT abd w) plus 72193 (CT pelvis w) on the same date for the same patient. NEVER do this; 74177 is the correct single code.
!Stacking 74176 and 74177 on the same date. The without-and-with combined code is 74178; choose that when both phases were obtained.
!Performing 74177 without contrast safety review. Post-contrast AKI in a patient with undocumented eGFR is a malpractice and billing audit risk; document the contrast-safety verification.
!Reading a CT urogram and billing 74177. The urogram has its own code (74178 plus 74174 component) when arterial and delayed excretory phases are obtained.
!Missing modifier 26 in a hospital-outpatient interpretation, defaulting to global billing. Setting-modifier audits are routine.

Common modifiers

26TC

Common ICD-10 pairings

R10.31K35.80K57.32K65.9C18.9K85.90

Payer notes

Medicare covers 74177 with appropriate indication and contrast-safety documentation. Outpatient prior authorization is common for commercial payers (UnitedHealthcare, Aetna, Anthem) when the study is non-urgent. ED-ordered 74177 is auto-approved post-care. Medicare Advantage plans frequently require prior auth for outpatient CT; document the indication and clinical urgency to support medical necessity.