CPT 74177: CT abdomen and pelvis with contrast
74177 reports one CT scan covering the abdomen and pelvis with contrast, and Medicare pays it as an active code with a professional part and a technical part. What sets it apart is the technical part, which is cut by 50 percent for a second scan in the same session and by 15 percent on non-compliant equipment.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 74177 is the CT of the abdomen and pelvis with contrast, billed globally or split with 26 and TC. The fee schedule file gives a global total of 8.99 RVUs, of which 2.51 is the reading. The contrast injection is not billed separately, and CMS no longer wants imaging AUC information on claims.
What does CPT 74177 report?
74177 reports one CT scan that covers the abdomen and the pelvis, done with contrast material. In the October 2026 fee schedule file (RVU26D) it is an active code, status A, with a professional part and a technical part.
The same file lists two relatives: 74176 for abdomen and pelvis without contrast, and 74178 for a scan without contrast followed by one with contrast. It also lists 74160 for the abdomen alone with contrast. Pick the code that matches the contrast sequence the radiologist documents.
| Item | Value in the file |
|---|---|
| Payment status | A (active code) |
| PC/TC indicator | 1 (modifiers 26 and TC allowed) |
| Work RVU | 1.77 |
| Total RVU, global / 26 / TC | 8.99 / 2.51 / 6.48 |
| Multiple procedure indicator | 4 (imaging reduction applies) |
| Imaging family indicator | 88 |
How is contrast handled when you bill 74177?
The scan code already includes the contrast study. NCCI Policy Manual Chapter IX says that when a procedure needs parenteral contrast, such as CT, the vascular access (36000, 36406, 36410) and the contrast administration (96360 to 96379) are integral and not separately reportable.
Chapter 13, section 30 of the Claims Processing Manual says the technical RVUs of CT codes that specify contrast include payment for high osmolar contrast. Low osmolar contrast is paid separately under the conditions in section 30.1.1, and for intravenous studies the older list of five restrictive criteria is gone. The HCPCS file for October 2026 carries low osmolar contrast as Q9965 to Q9967 by iodine strength, priced per ml, so units are milliliters, not scans.
What happens when a second scan is done in the same session?
A multiple procedure indicator of 4 means the technical component is paid at 100 percent for the highest priced scan and 50 percent for each later scan in the same imaging family on the same day. The fee schedule layout adds a 5 percent cut to the professional component of diagnostic imaging from January 1, 2017.
Remittances show this as CARC 59, "Processed based on multiple or concurrent procedure rules", and X12 names diagnostic imaging in its example. It is a reduction, not a denial, so check the amount paid before appealing.
What is the CT modifier and does it apply to 74177?
Yes. Chapter 13, section 20.2.4 lists 74150 to 74178 among the CT codes covered by a 15 percent cut to the technical component when the scanner does not meet the NEMA XR-29-2013 dose standard. Claims for those scans carry modifier CT, which triggers the cut, and the facility must attest the status of its equipment.
The scan is reported once per encounter for the full abdomen and pelvis. Chapter IX says that if images are repeated for quality or extra views, only one unit of the appropriate code is reported.
Does the imaging appropriate use program apply?
No. CMS paused the Appropriate Use Criteria program for advanced imaging and rescinded the regulations at 42 CFR 414.94, effective January 1, 2024. CMS says providers and suppliers should no longer put AUC consultation information on Medicare fee-for-service claims.
Prior authorization is a separate question. Medicare Advantage and commercial plans set their own rules, so confirm the plan's requirement through prior authorization checks and keep the order and clinical indication with the study.
How does 74177 appear on the claim?
On the CMS-1500, item 24D carries 74177 with 26, TC or CT as needed, item 24G carries 1 and item 24B carries the place of service, 23 for an ED patient. For the facility technical claim, the UB-04 carries the HCPCS code in FL 44 and units in FL 46.
The practitioner MUE table effective October 1, 2026 lists 74177 at 2 per date with adjudication indicator 3. The hospital side is paid under OPPS; its status indicator and APC are in OPPS Addendum B. Read the split in modifier 26 and modifier TC.
Which fields carry 74177 on a professional and facility claim?
A CT of the abdomen and pelvis with contrast is one line for the study. Item 24D carries 74177 with 26 or TC for a split, Item 24G holds 1 and Item 24B holds the place of service. Item 24E points to the symptom that justified the scan, such as abdominal pain.
On the hospital side, the UB-04 shows the CT revenue code in FL 42, 74177 in FL 44, the scan date in FL 45 and 1 in FL 46. Chapter 25 states that, for coded procedures, units equal the number of times it was done.
RVU26D gives 74177 status A and the MUE table allows 2 per date.
Example: An ED patient has right lower quadrant pain on 10/13. The professional read line is 74177 with 26, pointer A (R10.31), 1 unit, $145.00. The hospital bills the technical part on its own claim, so the unit appears once on each form and not twice on either.
Why does a 74177 claim deny?
| CARC | What X12 says | What usually causes it |
|---|---|---|
| 50 | Not deemed a medical necessity by the payer | Order or indication does not support the scan |
| 59 | Processed based on multiple or concurrent procedure rules | Second scan in the same session |
| 197 | Precertification/notification/authorization/pre-treatment exceeded | Plan required authorization for a non-emergency scan |
| 4 | The procedure code is inconsistent with the modifier used | CT, 26 or TC missing or combined wrongly |
If these denials keep coming back, our denial management team can work them.
Related codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- Medicare Claims Processing Manual, Chapter 13: Radiology Services and Other Diagnostic Procedures · CMS
- 2026 NCCI Medicare Policy Manual, Chapter IX: Radiology Services · CMS
- Appropriate Use Criteria Program (current status) · CMS
- HCPCS quarterly update (October 2026 files) · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- Medicare Claims Processing Manual, Chapter 25: Completing and Processing the Form CMS-1450 Data Set · CMS
- Claim Adjustment Reason Codes · X12
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Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01How is CT abdomen and pelvis with contrast reported?
Report 74177 once for the combined scan, with 26 for the reading or TC for the technical part when they are billed by different entities. The contrast study is part of the code, and the IV start and contrast injection are not billed separately.
02How do I bill CT head without contrast in the ED?
Not with 74177, which covers the abdomen and pelvis. A head CT without contrast is a different code in the 70000 series; the fee schedule file lists 70450 as head or brain CT without dye, with the same 26 and TC structure. Bill that code on its own line.
03Is the contrast agent billed with 74177?
Low osmolar contrast has its own HCPCS codes, Q9965 to Q9967, priced per ml. Chapter 13, section 30 says the technical RVUs for CT with contrast already include high osmolar contrast, so separate payment is for low osmolar agents under section 30.1.1.
04What is the MUE for 74177?
The practitioner services MUE table effective October 1, 2026 shows 2 units per date of service with adjudication indicator 3, a clinical date of service edit. Units above that on one date are denied unless an appeal supports them, so check the count on the claim before it goes out.
05Does 74177 need appropriate use criteria on the claim?
No. CMS paused the AUC program and rescinded 42 CFR 414.94 effective January 1, 2024, and says providers should no longer include AUC consultation information on Medicare fee-for-service claims. Authorization from Medicare Advantage or commercial plans is a separate step.
CT claims paid less than expected?
We check same-session reductions, the CT modifier and contrast lines before scan claims go out.