CPT® Code 74177

Quick Guide: CPT 74177

• Definition: Combined CT scan of the Abdomen AND Pelvis using IV contrast.
• Bundling: Replaces separate codes 74160 (Abdomen) and 72193 (Pelvis). Do not bill these separately.
• Contrast Rule: Requires intravascular (IV) contrast. Oral contrast alone does not qualify.
• Reimbursement: ~$304 (Medicare Global) to $497+ (Commercial).

CPT® 74177 represents a computed tomography (CT) scan of the abdomen and pelvis performed with contrast material(s). This single code bundles the imaging of both anatomical regions into one service to evaluate pathology spanning the abdominopelvic cavity. It is widely used for diagnosing conditions such as appendicitis, diverticulitis, and abdominal trauma.

Definition and Description

According to the AMA, CPT 74177 is formally defined as “Computed tomography, abdomen and pelvis; with contrast material(s).” This code covers imaging from the diaphragm down to the pelvic floor.

• Included Regions: Both the Abdomen and Pelvis must be imaged.
• Contrast Requirement: The procedure requires the administration of IV contrast. If only oral or rectal contrast is used, the scan should be coded as “Without Contrast” (74176).

flowchart TD
    A[CT Abdomen and Pelvis Ordered] --> B{Was IV contrast administered?}
    B -->|No IV contrast| C{Oral/rectal contrast only?}
    C -->|Yes or No| D[CPT 74176 - Without Contrast]
    B -->|Yes - Single phase IV contrast| E[CPT 74177 - With Contrast]
    B -->|Yes - Two phases: pre + post| F[CPT 74178 - Without and With]
    E --> G{Both abdomen AND pelvis imaged?}
    G -->|Yes| H[74177 is correct]
    G -->|Abdomen only| I[Use 74160 instead]
    G -->|Pelvis only| J[Use 72193 instead]

Code Comparison: 74176 vs 74177 vs 74178

Choosing the correct code depends entirely on the contrast protocol used. Use this table to select the correct CPT:

Clinical Indications & Medical Necessity

Payers like Florida Blue and UnitedHealthcare require specific clinical indications to justify the use of IV contrast. Common covered ICD-10 diagnoses include :

• R10.9: Unspecified abdominal pain (Acute abdomen).
• K35.80: Acute appendicitis.
• K57.32: Diverticulitis with abscess/perforation.
• C18.9: Malignant neoplasm of colon (Staging).
• S39.91XA: Unspecified injury of abdomen (Trauma).

Note: Routine screening is generally not covered by Medicare. There must be a specific sign, symptom, or known disease history .

Real-World Coding Examples

Scenario 1: Acute Appendicitis

Clinical: A 25-year-old patient presents to the ER with RLQ pain and fever. The physician orders a CT Abdomen/Pelvis. The patient drinks oral contrast, and IV contrast is administered. The scan reveals an inflamed appendix.

• Code: 74177 (CT Abd/Pelvis w/ Contrast).
• Diagnosis: K35.80 (Acute appendicitis).
• Why: Both contrast types were used, but IV contrast drives the code to “With Contrast”.

Scenario 2: Kidney Stone Protocol

Clinical: A patient presents with flank pain. The provider orders a CT Abdomen/Pelvis to rule out kidney stones. No IV or oral contrast is given to avoid obscuring the stone.

• Code: 74176 (CT Abd/Pelvis Without Contrast).
• Diagnosis: N20.0 (Calculus of kidney).
• Why: 74177 is incorrect because no contrast was administered.

NCCI Edits and Bundling Rules

The National Correct Coding Initiative (NCCI) prohibits unbundling this comprehensive service. When billing 74177, you cannot separately bill:

• 74150, 74160, 74170: CT Abdomen (any type).
• 72192, 72193, 72194: CT Pelvis (any type).
• 96374: IV Push/Injection (Contrast administration is included in the CT procedure).

Exception: You MAY bill for the contrast material supply itself (e.g., HCPCS Q9967) in non-hospital settings.

Commercial Payer Policies (Aetna, UHC, Cigna)

Commercial payers often have stricter requirements than Medicare regarding site of service and authorization.

• UnitedHealthcare (Site-of-Service): UHC often mandates that non-emergency CTs be performed at a freestanding imaging center rather than a hospital outpatient department to control costs. Failure to follow this can lead to denial.
• Aetna & Cigna (Prior Auth): Almost all elective outpatient CTs require prior authorization via radiology benefit managers (like eviCore). Emergency room scans are typically exempt but may be reviewed for necessity retroactively.
• Frequency Limits: Payers may deny repeat scans of the same region within a short window (e.g., 3-6 months) unless there is a clear change in clinical status or new symptoms.

Reimbursement & RVUs (2026 Estimates)

Reimbursement varies by payer and setting (Hospital vs. Freestanding Center). Below are the approximate 2026 Medicare national averages, alongside benchmarks from major commercial plans.

Commercial payers (e.g., Cigna, BCBS) often reimburse at 110%–150% of these Medicare rates. For facility-specific fee schedules, refer to BCBS TX data .

Frequently Asked Questions (FAQ)

Q: Can I bill 74177 if only oral contrast was used? A: No. If only oral contrast is administered, you must bill CPT 74176 (Without Contrast). To bill 74177, intravascular (IV) contrast is required.

Q: Can I bill separate codes for the abdomen (74160) and pelvis (72193)? A: No. When both regions are imaged in the same session, you must use the combined code 74177. Billing separate codes is considered unbundling and will be denied by NCCI edits.

Q: What causes denials for 74177? A: Common reasons include missing physician orders, lack of documented medical necessity (e.g., vague diagnosis codes), or failure to respond to Targeted Probe and Educate (TPE) documentation requests.