CPT code 74221: Esophagram, double contrast2026 Medicare rate & RVUs

Medicare pays $105.55 for 74221 nationally in the office. Local office rates run $93.29–$143.14.

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

What 74221 covers

This esophagram uses barium and a gas-producing contrast agent to show the esophageal lining and outline during fluoroscopic and radiographic imaging. Radiologists interpret the study, with imaging staff typically assisting in hospital radiology departments and outpatient imaging centers. It may be performed for symptoms such as dysphagia or suspected esophageal narrowing, diverticulum, or other structural abnormality.

Select this code when the performed examination uses the double-contrast technique; the technique documented in the imaging report, rather than the symptom alone, distinguishes it from a single-contrast esophagram. The report should identify the esophageal examination and findings, with the contrast technique documented. Bill the complete service without a component modifier when one entity provides both portions. Modifier 26 identifies the interpretation, while modifier TC identifies the equipment and staff portion when those components are billed separately.

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 74221 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

74221 rates by state

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

How the 74221 rate is calculated

Each of 74221’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 74221

The CMS indicators that decide how 74221 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

74221 compared with similar codes

How to choose

74220EsophagramSingle contrast

Choose 74221 when the esophagram uses double contrast; choose 74220 for a single-contrast technique.

74210Contrast X-rayPharynx and cervical esophagus

74210 focuses on the pharynx and cervical esophagus. This code represents a double-contrast examination of the esophagus.

74230Swallow studyRecorded fluoroscopic evaluation

74230 evaluates swallowing function radiographically. This code reports a double-contrast esophageal examination.

74246Upper GI imagingAir-contrast study

74246 is a double-contrast upper GI examination that evaluates a broader portion of the upper GI tract; this code is for the esophagus.

Codes related to 74221

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