CPT code 74221: Esophagram, double contrast2026 Medicare rate & RVUs in Missouri
Reports a radiographic esophageal examination using two contrast agents to assess swallowing-related symptoms and structural abnormalities of the esophagus.
Medicare pays $94.30–$101.65 for 74221 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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 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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$94.30 to $101.65
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $100.56 | Unavailable |
| Metropolitan St. Louis, MO | $101.65 | Unavailable |
| Rest of Missouri | $94.30 | Unavailable |
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.
How the rate is built · 74221
RVUs × geographic indexes × conversion factor
Work0.68
0.68 RVUs× 1.000 GPCI
Practice expense2.43
2.43 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
3.1600
Conversion factor
$33.4009
Medicare rate
$105.55
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 74221
The CMS indicators that decide how 74221 is paid alongside other services.
CMS payment indicators · 74221
Esophagram, double 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
74221 without 26 · national office
$105.55
Esophagram, double contrast
74221-26 · Professional component
$32.06
Pays only the interpretation and report.
74221 compared with similar codes
Compare codes · National
5 codes, side by side
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.
74221 billing questions
How is this code distinguished from 74220?
This code represents a double-contrast esophageal examination using barium and a gas-producing agent. Code 74220 is for a single-contrast esophageal examination.
When should modifier 26 or TC be used?
Use modifier 26 for the radiologist's interpretation and modifier TC for the technical service, including equipment and staff, when billing those portions separately. Report the global service without either modifier when both portions are billed together.
Does this code describe a swallowing-function study?
No. It describes an esophageal contrast examination. Code 74230 is used for a radiographic swallowing-function study.
What documentation supports reporting the double-contrast code?
The imaging documentation should establish that an esophageal examination was performed using the double-contrast technique. The report should also identify the examined anatomy and findings.
Should this code be used for an upper GI examination?
Use this code for an examination focused on the esophagus. Code 74246 describes a double-contrast upper GI examination that includes evaluation beyond the esophagus.
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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