CPT code 74246: Upper GI imaging, air-contrast study2026 Medicare rate & RVUs in Puerto Rico
Reports fluoroscopic double-contrast imaging of the esophagus, stomach, and proximal small bowel during an air-contrast upper gastrointestinal series.
In Puerto Rico, Medicare pays $135.71 for 74246 in the office.
Check a contract rate as a % of Medicare · 74246 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 74246 covers
This examination uses fluoroscopy and radiographs to assess the esophagus, stomach, and duodenum, sometimes extending to the proximal jejunum. The patient swallows contrast, typically high-density barium with an effervescent agent that distends the upper GI tract with gas. A radiologist guides the study and interprets the images, with a technologist assisting with imaging. It is commonly performed in a hospital radiology department or outpatient imaging center to evaluate symptoms or suspected structural abnormalities such as a hiatal hernia or ulcer.
Select this code when the documented examination uses an air-contrast protocol to image the upper GI tract; a single-contrast study is reported differently. The record should support the anatomic coverage, contrast technique, and final interpretation. CMS recognizes separately priced professional and technical components: modifier 26 identifies the interpretation, and modifier TC identifies equipment and staff. Reporting without either modifier represents the global service.
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.
How Puerto Rico compares for 74246
Across 109 of 109 payment localities, the office rate for 74246 runs from $119.08 in Arkansas to $182.53 in San Benito County, CA. Puerto Rico pays $135.71. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$135.71
- Los Angeles, CA · California$154.02+$18.31
- Washington, DC area · District of Columbia$154.79+$19.08
- Miami, FL · Florida$141.90+$6.19
- Chicago, IL · Illinois$137.92+$2.21
- Manhattan, NY · New York$154.38+$18.67
- Alaska · Alaska$155.11+$19.40
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $120.83 | — |
| ArkansasArkansas | $119.08 | — |
| ArizonaArizona | $131.12 | — |
| Bakersfield, CACalifornia | $144.29 | — |
| Chico, CACalifornia | $144.08 | — |
| El Centro, CACalifornia | $144.09 | — |
| Fresno, CACalifornia | $144.08 | — |
| Hanford, CACalifornia | $144.08 | — |
| Madera, CACalifornia | $144.08 | — |
| Merced, CACalifornia | $144.08 | — |
| Modesto, CACalifornia | $144.08 | — |
| Napa, CACalifornia | $168.29 | — |
| Oxnard, CACalifornia | $153.46 | — |
| Redding, CACalifornia | $144.08 | — |
| Rest of CaliforniaCalifornia | $144.08 | — |
| Riverside, CACalifornia | $144.75 | — |
| Sacramento, CACalifornia | $151.56 | — |
| Salinas, CACalifornia | $151.00 | — |
| San Diego, CACalifornia | $154.80 | — |
| Marin County, CACalifornia | $178.63 | — |
| San Francisco, CACalifornia | $178.56 | — |
| San Benito County, CACalifornia | $182.53 | — |
| Santa Clara County, CACalifornia | $182.25 | — |
| San Luis Obispo, CACalifornia | $148.52 | — |
| Santa Cruz, CACalifornia | $156.48 | — |
| Santa Maria, CACalifornia | $151.63 | — |
| Santa Rosa, CACalifornia | $158.09 | — |
| Stockton, CACalifornia | $144.08 | — |
| Vallejo, CACalifornia | $168.19 | — |
| Visalia, CACalifornia | $144.08 | — |
| Yuba City, CACalifornia | $144.08 | — |
| ColoradoColorado | $141.12 | — |
| ConnecticutConnecticut | $143.56 | — |
| DelawareDelaware | $133.31 | — |
| Fort Lauderdale, FLFlorida | $137.57 | — |
| Rest of FloridaFlorida | $131.07 | — |
| Atlanta, GAGeorgia | $136.75 | — |
| Rest of GeorgiaGeorgia | $123.84 | — |
| Hawaii, Guam, HIHawaii | $147.90 | — |
| IowaIowa | $124.62 | — |
| IdahoIdaho | $125.29 | — |
| East St. Louis, ILIllinois | $128.38 | — |
| Rest of IllinoisIllinois | $126.75 | — |
| Suburban Chicago, ILIllinois | $139.15 | — |
| IndianaIndiana | $126.04 | — |
| KansasKansas | $123.70 | — |
| KentuckyKentucky | $122.98 | — |
| New Orleans, LALouisiana | $128.79 | — |
| Rest of LouisianaLouisiana | $122.65 | — |
| Metropolitan Boston, MAMassachusetts | $155.61 | — |
| Rest of MassachusettsMassachusetts | $140.14 | — |
| Baltimore area, MDMaryland | $143.09 | — |
| Rest of MarylandMaryland | $135.97 | — |
| Rest of MaineMaine | $125.59 | — |
| Southern Maine, MEMaine | $132.94 | — |
| Detroit, MIMichigan | $132.37 | — |
| Rest of MichiganMichigan | $125.88 | — |
| MinnesotaMinnesota | $136.19 | — |
| Metropolitan Kansas City, MOMissouri | $128.26 | — |
| Metropolitan St. Louis, MOMissouri | $129.66 | — |
| Rest of MissouriMissouri | $120.31 | — |
| MississippiMississippi | $119.74 | — |
| MontanaMontana | $134.60 | — |
| North CarolinaNorth Carolina | $126.97 | — |
| North DakotaNorth Dakota | $133.42 | — |
| NebraskaNebraska | $125.41 | — |
| New HampshireNew Hampshire | $138.59 | — |
| Northern New JerseyNew Jersey | $153.11 | — |
| Rest of New JerseyNew Jersey | $145.47 | — |
| New MexicoNew Mexico | $126.44 | — |
| NevadaNevada | $134.37 | — |
| NYC suburbs and Long Island, NYNew York | $157.71 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $146.15 | — |
| Queens, NYNew York | $156.16 | — |
| Rest of New YorkNew York | $128.85 | — |
| OhioOhio | $125.64 | — |
| OklahomaOklahoma | $123.12 | — |
| Portland, OROregon | $146.02 | — |
| Rest of OregonOregon | $133.60 | — |
| Metropolitan Philadelphia, PAPennsylvania | $139.75 | — |
| Rest of PennsylvaniaPennsylvania | $126.03 | — |
| Rhode IslandRhode Island | $138.35 | — |
| South CarolinaSouth Carolina | $126.46 | — |
| South DakotaSouth Dakota | $133.27 | — |
| TennesseeTennessee | $124.29 | — |
| Austin, TXTexas | $140.42 | — |
| Beaumont, TXTexas | $125.17 | — |
| Brazoria, TXTexas | $133.47 | — |
| Dallas, TXTexas | $134.17 | — |
| Fort Worth, TXTexas | $133.17 | — |
| Galveston, TXTexas | $133.77 | — |
| Houston, TXTexas | $134.87 | — |
| Rest of TexasTexas | $129.15 | — |
| UtahUtah | $128.21 | — |
| VirginiaVirginia | $132.26 | — |
| Virgin Islands, VIUnited States Virgin Islands | $135.71 | — |
| VermontVermont | $132.58 | — |
| Rest of WashingtonWashington | $139.98 | — |
| King County, WAWashington | $159.14 | — |
| WisconsinWisconsin | $128.88 | — |
| West VirginiaWest Virginia | $121.95 | — |
| WyomingWyoming | $134.08 | — |
74246 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$119.08
$163.31
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $155.11 | 1 |
| AL | $120.83 | 1 |
| AR | $119.08 | 1 |
| AZ | $131.12 | 1 |
| CA | $144.08–$182.53 | 29 |
| CO | $141.12 | 1 |
| CT | $143.56 | 1 |
| DC | $154.79 | 1 |
| DE | $133.31 | 1 |
| FL | $131.07–$141.90 | 3 |
| GA | $123.84–$136.75 | 2 |
| GU | $147.90 | 1 |
| HI | $147.90 | 1 |
| IA | $124.62 | 1 |
| ID | $125.29 | 1 |
| IL | $126.75–$139.15 | 4 |
| IN | $126.04 | 1 |
| KS | $123.70 | 1 |
| KY | $122.98 | 1 |
| LA | $122.65–$128.79 | 2 |
| MA | $140.14–$155.61 | 2 |
| MD | $135.97–$154.79 | 3 |
| ME | $125.59–$132.94 | 2 |
| MI | $125.88–$132.37 | 2 |
| MN | $136.19 | 1 |
| MO | $120.31–$129.66 | 3 |
| MS | $119.74 | 1 |
| MT | $134.60 | 1 |
| NC | $126.97 | 1 |
| ND | $133.42 | 1 |
| NE | $125.41 | 1 |
| NH | $138.59 | 1 |
| NJ | $145.47–$153.11 | 2 |
| NM | $126.44 | 1 |
| NV | $134.37 | 1 |
| NY | $128.85–$157.71 | 5 |
| OH | $125.64 | 1 |
| OK | $123.12 | 1 |
| OR | $133.60–$146.02 | 2 |
| PA | $126.03–$139.75 | 2 |
| PR | $135.71 | 1 |
| RI | $138.35 | 1 |
| SC | $126.46 | 1 |
| SD | $133.27 | 1 |
| TN | $124.29 | 1 |
| TX | $125.17–$140.42 | 8 |
| UT | $128.21 | 1 |
| VA | $132.26–$154.79 | 2 |
| VI | $135.71 | 1 |
| VT | $132.58 | 1 |
| WA | $139.98–$159.14 | 2 |
| WI | $128.88 | 1 |
| WV | $121.95 | 1 |
| WY | $134.08 | 1 |
How the 74246 rate is calculated
Each of 74246’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 · 74246
RVUs × geographic indexes × conversion factor
Work0.88
0.88 RVUs× 1.000 GPCI
Practice expense3.09
3.09 RVUs× 1.000 GPCI
Malpractice0.06
0.06 RVUs× 1.000 GPCI
Adjusted RVUs
4.0300
Conversion factor
$33.4009
Medicare rate
$134.61
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
8,357
- Code
- 74246
- Physician work
- 0.88
- Practice expense
- 3.09
- Malpractice
- 0.06
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.88 | × 1.000 | 0.8800 |
| Practice expense | 3.09 | × 1.011 | 3.1240 |
| Malpractice | 0.06 | × 0.985 | 0.0591 |
| Total RVUs | 4.0631 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$135.71
Office: (0.88 × 1 + 3.09 × 1.011 + 0.06 × 0.985) × $33.4009 = $135.71
Payment rules and modifiers for 74246
The CMS indicators that decide how 74246 is paid alongside other services.
CMS payment indicators · 74246
Upper GI imaging, air-contrast study
| 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
74246 without 26 · national office
$134.61
Upper GI imaging, air-contrast study
74246-26 · Professional component
$41.75
Pays only the interpretation and report.
How 74246 has changed in Puerto Rico
74246 · Office / nonfacility
$135.71
Effective 2026-10-01
The base rate is $2.73 higher than on 2025-10-01, moving from $132.98 to $135.71 (2.1%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$132.98changed to$135.71
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.90 changed to 0.88
- Practice expense RVU 3.14 changed to 3.09
- Malpractice RVU 0.05 changed to 0.06
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$139.52changed to$132.98
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 3.21 changed to 3.14
- Malpractice RVU 0.06 changed to 0.05
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$137.24changed to$139.52
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$144.55changed to$137.24
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 3.29 changed to 3.21
- Malpractice RVU 0.05 changed to 0.06
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$143.68changed to$144.55
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$149.71changed to$143.68
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 3.35 changed to 3.29
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$147.79changed to$149.71
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 3.26 changed to 3.35
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$141.57changed to$147.79
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 2.94 changed to 3.26
- Malpractice RVU 0.06 changed to 0.05
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$139.15changed to$141.57
- Conversion factor 36.0391 changed to 36.0896
- Work RVU 0.69 changed to 0.90
- Practice expense RVU 3.10 changed to 2.94
- Malpractice RVU 0.05 changed to 0.06
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$129.21changed to$139.15
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.83 changed to 3.10
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$113.16changed to$129.21
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 2.84 changed to 2.83
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$96.92changed to$113.16
- Conversion factor 35.8043 changed to 35.8887
- Practice expense GPCI 0.705 changed to 0.856
- Malpractice GPCI 0.293 changed to 0.642
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$97.22changed to$96.92
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 2.83 changed to 2.84
- Malpractice RVU 0.07 changed to 0.05
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$96.74changed to$97.22
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$98.33changed to$96.74
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 2.95 changed to 2.83
- Malpractice RVU 0.05 changed to 0.07
- Practice expense GPCI 0.692 changed to 0.705
- Malpractice GPCI 0.271 changed to 0.293
Held through RVU15B.
January 1, 2014
RVU14A
$96.33changed to$98.33
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 3.14 changed to 2.95
- Practice expense GPCI 0.678 changed to 0.692
- Malpractice GPCI 0.249 changed to 0.271
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $96.33
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $135.71 | Not available in this setting | RVU26D |
| 2026-07-01 | $135.71 | Not available in this setting | RVU26C |
| 2026-04-01 | $135.71 | Not available in this setting | RVU26B |
| 2026-01-01 | $135.71 | Not available in this setting | RVU26A |
| 2025-10-01 | $132.98 | Not available in this setting | RVU25D |
| 2025-07-01 | $132.98 | Not available in this setting | RVU25C |
| 2025-04-01 | $132.98 | Not available in this setting | RVU25B |
| 2025-01-01 | $132.98 | Not available in this setting | RVU25A |
| 2024-10-01 | $139.52 | Not available in this setting | RVU24D |
| 2024-07-01 | $139.52 | Not available in this setting | RVU24C |
| 2024-04-01 | $139.52 | Not available in this setting | RVU24B |
| 2024-03-09 | $139.52 | Not available in this setting | RVU24AR |
| 2024-01-01 | $137.24 | Not available in this setting | RVU24A |
| 2023-10-01 | $144.55 | Not available in this setting | RVU23D |
| 2023-07-01 | $143.68 | Not available in this setting | RVU23C |
| 2023-04-01 | $143.68 | Not available in this setting | RVU23B |
| 2023-01-01 | $143.68 | Not available in this setting | RVU23A |
| 2022-10-01 | $149.71 | Not available in this setting | RVU22D |
| 2022-07-01 | $149.71 | Not available in this setting | RVU22C |
| 2022-04-01 | $149.71 | Not available in this setting | RVU22B |
| 2022-01-01 | $149.71 | Not available in this setting | RVU22A |
| 2021-10-01 | $147.79 | Not available in this setting | RVU21D |
| 2021-07-01 | $147.79 | Not available in this setting | RVU21C |
| 2021-04-01 | $147.79 | Not available in this setting | RVU21B |
| 2021-01-01 | $147.79 | Not available in this setting | RVU21A |
| 2020-10-01 | $141.57 | Not available in this setting | RVU20D |
| 2020-07-01 | $141.57 | Not available in this setting | RVU20C |
| 2020-04-01 | $141.57 | Not available in this setting | RVU20B |
| 2020-01-01 | $141.57 | Not available in this setting | RVU20A |
| 2019-10-01 | $139.15 | Not available in this setting | RVU19D |
| 2019-07-01 | $139.15 | Not available in this setting | RVU19C |
| 2019-04-01 | $139.15 | Not available in this setting | RVU19B |
| 2019-01-01 | $139.15 | Not available in this setting | RVU19A |
| 2018-10-01 | $129.21 | Not available in this setting | RVU18D |
| 2018-07-01 | $129.21 | Not available in this setting | RVU18C |
| 2018-04-01 | $129.21 | Not available in this setting | RVU18B |
| 2018-01-01 | $129.21 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $113.16 | Not available in this setting | RVU17D |
| 2017-07-01 | $113.16 | Not available in this setting | RVU17C |
| 2017-04-01 | $113.16 | Not available in this setting | RVU17B |
| 2017-01-01 | $113.16 | Not available in this setting | RVU17A |
| 2016-10-01 | $96.92 | Not available in this setting | RVU16D |
| 2016-07-01 | $96.92 | Not available in this setting | RVU16C |
| 2016-04-01 | $96.92 | Not available in this setting | RVU16B |
| 2016-01-01 | $96.92 | Not available in this setting | RVU16A |
| 2015-10-01 | $97.22 | Not available in this setting | RVU15D |
| 2015-07-01 | $97.22 | Not available in this setting | RVU15C |
| 2015-04-01 | $96.74 | Not available in this setting | RVU15B |
| 2015-01-01 | $96.74 | Not available in this setting | RVU15A |
| 2014-10-01 | $98.33 | Not available in this setting | RVU14D |
| 2014-07-01 | $98.33 | Not available in this setting | RVU14C |
| 2014-04-01 | $98.33 | Not available in this setting | RVU14B |
| 2014-01-01 | $98.33 | Not available in this setting | RVU14A |
| 2013-10-01 | $96.33 | Not available in this setting | RVU13D |
| 2013-07-01 | $96.33 | Not available in this setting | RVU13C |
| 2013-04-01 | $96.33 | Not available in this setting | RVU13B |
| 2013-01-01 | $96.33 | Not available in this setting | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
74246 billing questions
How does this differ from 74240?
74246 is for an air-contrast upper GI examination. Use 74240 for an upper GI study performed with single contrast.
When should the esophagus-only codes be used instead?
Use 74220 or 74221 when the examination is limited to the esophagus and matches the applicable contrast technique. This code covers a broader upper GI examination.
Can the professional and technical services be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service. Without either modifier, the claim represents the global service.
What documentation supports reporting 74246?
The report should identify the upper GI anatomy examined, the air-contrast technique, and the interpreting physician's findings. The imaging record should support that the study was not single contrast.
Does this code describe a small-bowel follow-through?
No. It describes an air-contrast upper GI examination. A study focused on serial imaging of the small intestine is coded according to its own procedure and contrast method.
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
Show the CMS file lines behind this rate
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