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CMS RVU26D · Effective 2026-10-01

74221 Esophagram Medicare reimbursement rates in Alaska

Reports a radiographic esophageal examination using two contrast agents to assess swallowing-related symptoms and structural abnormalities of the esophagus. Compare 74221 office and facility rates across CMS payment localities in Alaska.

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

What does Medicare pay for 74221 in Alaska?

Alaska has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.

Office / nonfacility

$121.43

1 of 1 localities have a supported rate.

Payment area: Alaska*

One mapped payment locality.

Facility setting

No supported rate

These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.

Find 74221 in your payment locality →

Radiology

About 74221: Double-contrast esophageal radiographic exam

Reports a radiographic esophageal examination using two contrast agents to assess swallowing-related symptoms and structural abnormalities of the esophagus.

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.

CMS billing rules for 74221

Professional and technical components
Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.

Where the value comes from

  • Work RVU0.68 · 22%
  • Practice expense (office) RVU2.43 · 77%
  • Malpractice RVU0.05 · 2%

73.6K

Medicare services in 2024 · #652 by national volume

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.

74221 compared with similar codes

Office rates for Alaska, from the same CMS release.

74220

Esophagram

Single contrast

$108.20

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

74210

Contrast X-ray

Pharynx and cervical esophagus

$104.85

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

74230

Swallow study

Recorded fluoroscopic evaluation

$134.93

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

74246

Upper GI imaging

Air-contrast study

$155.11

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

Compare 74221 by payment locality

Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.

1 of 1 payment localities

Office and facility base rates · shared scale starting at $0

  • Alaska* →

    Office / nonfacility

    $121.43

    Facility

    Unavailable

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 74221 in Alaska*.

PPRRVU2026_Oct_nonQPP.csv

8,345

Code
74221
Physician work
0.68
Practice expense
2.43
Malpractice
0.05

GPCI2026.csv

5

Locality
Alaska*
Physician work
1.500
Practice expense
1.065
Malpractice
0.551
Office / nonfacility calculation for 74221 in Alaska*
ComponentRVULocality factorAdjusted
Physician work0.68× 1.5001.0200
Practice expense2.43× 1.0652.5880
Malpractice0.05× 0.5510.0276
Total RVUs3.6355
Conversion factor× 33.4009

Office / nonfacility rate, Alaska*$121.43

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.
Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.681.5
Practice expense2.431.065
Malpractice0.050.551

(0.68 × 1.5 + 2.43 × 1.065 + 0.05 × 0.551) × $33.4009 = $121.43

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 74221PPRRVU2026_Oct_nonQPP.csv, line 8,345 (RVU26D)
Geographic factors for Alaska*GPCI2026.csv, line 5 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet