CPT code 74251: Small bowel X-ray, double contrast2026 Medicare rate & RVUs

Medicare pays $343.70 for 74251 nationally in the office.

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

What 74251 covers

This examination uses fluoroscopy and radiographs to assess the small intestine after administration of positive and negative contrast, such as barium and air. The radiologist observes contrast passage and bowel detail and may obtain serial images. It is typically performed in a radiology department when a clinician requests an anatomic assessment of the small bowel using a double-contrast technique.

Select 74251 when the documented examination evaluates the small intestine with double contrast; 74250 describes a single-contrast examination, while 74248 identifies a small-bowel follow-through. The report should identify the imaged region and support the contrast technique performed. For Medicare billing, modifier 26 represents the professional interpretation, while modifier TC represents the equipment and staff portion. Billing 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.

Where 74251 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

74251 rates by state

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

How the 74251 rate is calculated

Each of 74251’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 74251

The CMS indicators that decide how 74251 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

74251 compared with similar codes

How to choose

74250Small-bowel X-raySingle contrast

Both examine the small intestine, but 74250 is the single-contrast study; 74251 is selected for a double-contrast technique.

74248Small bowel follow-throughAdd-on to upper GI

74248 represents a small-bowel follow-through. Select 74251 for a documented double-contrast small-intestine examination, not simply because serial images were obtained.

74246Upper GI imagingAir-contrast study

74246 examines the upper gastrointestinal tract with double contrast. Use 74251 for the small intestine; report both only when each examination is separately performed and documented.

Codes related to 74251

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