CT of the abdomen and pelvis with a non-contrast series followed by one or more contrast series, used when both phases are needed to answer the clinical question.
- Medicare
- $338.02
- Work RVU
- 1.96
- Global, days
- Region
- Other
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Reason a multiphase study was needed
- Both non-contrast and contrast series described in the report
- Contrast agent and dose
- Signed interpretation
- Authorization for outpatient studies when required
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
74178 covers an abdomen and pelvis CT that is first done without contrast and then repeated with contrast, or that includes multiple contrast phases. It is used for bleeding questions, renal masses, and some complex postoperative evaluations. In orthopedic practice, it may follow spine or pelvic surgery when the team is looking for active bleeding, a urinary tract injury, or a collection.
The same combined-code rules apply as for 74176 and 74177. Do not bill separate abdomen and pelvis codes, and do not stack 72192 to 72194 on the same session. Both phases must be documented and interpreted. If the technologist only acquired the contrast images, the correct code is 74177.
Payers watch 74178 because it pays more than 74177. A diagnosis like abdominal pain alone may not support a multiphase study. The order or the radiology protocol should state why the non-contrast series was needed, such as baseline density for a hematoma or a bleeding protocol.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (1.96) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.12) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.96 |
| Practice expense RVU | 8.01 |
| Malpractice RVU | 0.15 |
| Total RVU | 10.12 |
| Medicare national rate | $338.02 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $338.02 |
HOPD (APC 5572) Hospital outpatient department | $356.43 |
Common denial reasons
The recurring reasons claims for CPT 74178 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Only contrast images acquired, so 74177 applied
- Diagnosis does not support a multiphase study
- Billed with separate pelvis CT codes for the same session
- Authorization issued for 74177
- Missing 26 modifier on hospital read
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What is the difference between 74177 and 74178?
02Can I bill 74178 with 72194?
03Why was 74178 downcoded?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes capture the bleeding or postoperative concern behind a multiphase CT, which is what payers look for before paying the higher code.
See how Mira captures CPT 74178 documentation