CPT code 74220: Esophagram, single contrast2026 Medicare rate & RVUs in California
A single-contrast fluoroscopic esophagram evaluates the esophageal lumen and passage of contrast, commonly for dysphagia, suspected narrowing, or other esophageal symptoms.
Medicare pays $100.93–$128.07 for 74220 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 74220 covers
A single-contrast esophagram is a fluoroscopic X-ray examination in which the patient swallows contrast, usually barium, while images document its passage through the esophagus. It is commonly ordered for dysphagia, suspected esophageal narrowing, diverticulum, or other structural symptoms. Radiologists typically interpret the examination, with imaging staff acquiring views in a hospital radiology department or outpatient imaging center. The study focuses on the esophagus rather than the oral and pharyngeal phases of swallowing or a broader upper gastrointestinal examination.
Select this code when the performed esophageal study uses a single-contrast technique; a double-contrast examination belongs to its sibling code. The report should support the technique and anatomy examined and include the radiologist’s interpretation. CMS permits global billing without a component modifier or split billing: modifier 26 represents the professional interpretation, and modifier TC represents the equipment and staff. The global service includes both 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 74220 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$100.93 to $128.07
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $101.06 | Unavailable |
| Chico, CA | $100.93 | Unavailable |
| El Centro, CA | $100.93 | Unavailable |
| Fresno, CA | $100.93 | Unavailable |
| Hanford, CA | $100.93 | Unavailable |
| Los Angeles, CA | $107.94 | Unavailable |
| Madera, CA | $100.93 | Unavailable |
| Marin County, CA | $125.33 | Unavailable |
| Merced, CA | $100.93 | Unavailable |
| Modesto, CA | $100.93 | Unavailable |
| Napa, CA | $118.04 | Unavailable |
| Oxnard, CA | $107.55 | Unavailable |
| Redding, CA | $100.93 | Unavailable |
| Rest of California | $100.93 | Unavailable |
| Riverside, CA | $101.37 | Unavailable |
| Sacramento, CA | $106.20 | Unavailable |
| Salinas, CA | $105.81 | Unavailable |
| San Benito County, CA | $128.07 | Unavailable |
| San Diego, CA | $108.51 | Unavailable |
| San Francisco, CA | $125.29 | Unavailable |
| San Luis Obispo, CA | $104.07 | Unavailable |
| Santa Clara County, CA | $127.88 | Unavailable |
| Santa Cruz, CA | $109.71 | Unavailable |
| Santa Maria, CA | $106.26 | Unavailable |
| Santa Rosa, CA | $110.84 | Unavailable |
| Stockton, CA | $100.93 | Unavailable |
| Vallejo, CA | $117.97 | Unavailable |
| Visalia, CA | $100.93 | Unavailable |
| Yuba City, CA | $100.93 | Unavailable |
How the 74220 rate is calculated
Each of 74220’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.
How the rate is built · 74220
RVUs × geographic indexes × conversion factor
Work0.59
0.59 RVUs× 1.000 GPCI
Practice expense2.19
2.19 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
2.8200
Conversion factor
$33.4009
Medicare rate
$94.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 74220
The CMS indicators that decide how 74220 is paid alongside other services.
CMS payment indicators · 74220
Esophagram, single contrast
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
74220 without 26 · national office
$94.19
Esophagram, single contrast
74220-26 · Professional component
$27.72
Pays only the interpretation and report.
74220 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 74221EsophagramDouble contrast
- Both codes examine the esophagus, but 74220 is for a single-contrast technique and 74221 is for a double-contrast technique.
- 74210Contrast X-rayPharynx and cervical esophagus
- 74210 focuses on the pharynx and/or cervical esophagus; 74220 is for a single-contrast examination of the esophagus.
- 74230Swallow studyRecorded fluoroscopic evaluation
- 74230 evaluates swallowing function, including oral and pharyngeal phases. Choose 74220 for a single-contrast esophageal examination.
- 74240Upper GI seriesSingle contrast
- 74240 is an upper gastrointestinal examination, while 74220 is focused on the esophagus.
74220 billing questions
How does this differ from the double-contrast esophagram?
Use 74220 for a single-contrast technique. When the examination uses double contrast, report 74221 instead.
When should the swallowing-function study be reported instead?
Use 74230 for a study focused on swallowing function, including the oral and pharyngeal phases. Use 74220 for a single-contrast examination focused on the esophagus.
Can the professional and technical portions be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical portion, including equipment and staff. Billing without either modifier represents the global service.
What documentation supports reporting 74220?
Document the clinical indication, that the examination used a single-contrast technique, the esophageal anatomy evaluated, and the imaging findings and interpretation.
Does this code include an examination of the stomach?
No. This code represents an esophageal study. A broader upper gastrointestinal examination is a different service when the stomach and related anatomy are evaluated.
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
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