CPT code 74178: CT abdomen/pelvis, without and with contrast2026 Medicare rate & RVUs

Medicare pays $338.02 for 74178 nationally in the office. Local office rates run $297.86–$461.15.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 74178 covers

This service includes CT images of both the abdomen and pelvis acquired without contrast and additional images acquired after contrast is administered. It may be used when the diagnostic question calls for comparison of unenhanced and contrast-enhanced findings, such as characterization of an abdominal or pelvic mass. A technologist performs the scan in a hospital imaging department, outpatient imaging center, or equipped physician office; a radiologist or other qualified physician interprets the images.

Select this code when the documented examination includes both body regions and both imaging phases. The report should support the anatomic coverage, use of contrast, and findings relevant to the clinical indication. Report the combined study rather than separate codes for its unenhanced and enhanced phases. The service may be billed globally, or the professional interpretation with modifier 26 and the technical portion with modifier TC. When multiple diagnostic imaging services are furnished, the CMS multiple procedure reduction applies to both the professional and technical components.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 74178 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

74178 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 74178 rate is calculated

Each of 74178’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 74178

The CMS indicators that decide how 74178 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

74178 compared with similar codes

How to choose

74176CT abdomen and pelvisWithout contrast

Use 74176 for an abdomen-and-pelvis CT performed without contrast only. This code requires both unenhanced and post-contrast imaging.

74177CT abdomen and pelvisWith contrast only

Use 74177 for an abdomen-and-pelvis CT with contrast when no unenhanced phase is performed. This code includes imaging both before and after contrast.

74170Abdominal CTWithout and with contrast

74170 covers the abdomen only with unenhanced and post-contrast imaging. Choose this code when the examination also includes the pelvis.

74174CTA abdomen/pelvisWith contrast

74174 is for angiographic imaging of the abdomen and pelvis, rather than a routine CT examination with unenhanced and contrast-enhanced phases.

Codes related to 74178

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates