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74260
Quick jump to procedure code: Printer Friendly Version
74262

CPT® 74261: COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITHOUT CONTRAST MATERIAL

Short Description: Ct colonography dx

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
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2016 Physician
Fee Schedule:

Global Fee $488.33
* 26 Modifier $122.89
* TC Modifier $365.44

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 Unadjusted OPPS Payment $112.49
2016 Unadjusted ASC Payment $ 62.90


*Based on National 2013 Medicare Part B submitted claims.
2016 APC Code: 5570
Computed Tomography without Contrast

Composite APC: 8005
CT and CTA without Contrast Composite

2016 OPPS Status Indicator: Q3

* This procedure is subject to the Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Imaging Procedures - CMS Transmittal 1104

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
16.7% 562.10    Diverticulosis of colon without hemorrhage K57.30   Diverticulosis of large intestine without perforation or abscess without bleeding
8.0% 211.3    Benign neoplasm of colon D12.0   Benign neoplasm of cecum
OR:
D12.1   Benign neoplasm of appendix
OR:
D12.6   Benign neoplasm of colon, unspecified
OR:
K63.5   Polyp of colon
8.0% V64.3    Procedure not carried out for other reasons Z53.8   Procedure and treatment not carried out for other reasons
3.5% V49.89    Other conditions influencing health status, other specified conditions Z78.9   Other specified health status
3.3% 560.9    Unspecified intestinal obstruction K56.60   Unspecified intestinal obstruction
3.3% V12.72    Personal history of colonic polyps Z86.010   Personal history of colonic polyps
2.9% 564.89    Other functional disorders of intestine K59.8   Other specified functional intestinal disorders
2.9% 569.89    Other specified disorder of intestine K63.4   Enteroptosis
OR:
K63.89   Other specified diseases of intestine
2.9% 789.00    Abdominal pain, unspecified site R10.9   Unspecified abdominal pain
2.9% 997.4    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

74261 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 74261

CCI and MUE Edits*         Hide this section.

CCI Edits for 74261
Denied Codes (1)
Effective
Modifier
Accepted (2)
01922 Anesth cat or mri scan
01/01/2010 No
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
72192 Ct pelvis w/o dye
01/01/2010 No
72193 Ct pelvis w/dye
01/01/2010 No
72194 Ct pelvis w/o & w/dye
01/01/2010 No
74150 Ct abdomen w/o dye
01/01/2010 No
74160 Ct abdomen w/dye
01/01/2010 No
74170 Ct abdomen w/o & w/dye
01/01/2010 No
74176 Ct abd & pelvis w/o contrast
01/01/2011 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
74177 Ct abd & pelv w/contrast
01/01/2011 No
74178 Ct abd & pelv 1/> regns
01/01/2011 No
74263 Ct colonography screening
07/01/2011 Yes
76000 Fluoroscope examination
01/01/2010 Yes
76001 Fluoroscope exam extensive
01/01/2011 Yes
76376 3d render w/intrp postproces
01/01/2010 Yes
76377 3d render w/intrp postproces
01/01/2010 Yes
77001 Fluoroguide for vein device
01/01/2011 Yes
77002 Needle localization by xray
01/01/2011 Yes
74262 Ct colonography dx w/dye
01/01/2010 No
(1) These codes will be denied when submitted for payment on the same date of service as 74261.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 74261


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Anatomic Consideration Anatomic Consideration Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   74261 Top 5 Ordering Providers National*
MARK KLEIN -WASHINGTON,DC 116
ZAHOOR MAKHDOOM -CARBONDALE,IL 108
ERIC SCHNIPPER -GARDEN CITY,NY 98
NEAL DALRYMPLE -SAN ANTONIO,TX 91
AMARNATH SORTUR -NEWARK,DE 89

   74261 Top 5 Ordering Organizations National*
ADVANCED IMAGING CENTER, LLC-IL 38
BUFORD ROAD IMAGING LLC-VA 30
TWIN PEAKS MEDICAL IMAGING LLC-CO 27
BTDI JV LLP-TX 25
MID-MICHIGAN MRI, INC.-MI 22

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 74261*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 13,727
Total Services Denied 2014: 4,548 (33.1%)
National Charges Submitted 2014: $ 9,190,149.00
National Charges Allowed 2014: $ 1,651,775.00
National Average (No Modifier) Fee Submitted 2014: $1033.43
National Average (No Modifier) Fee Allowed 2014: $256.67
National Average (26) Fee Submitted 2014: $378.09
National Average (26) Fee Allowed 2014: $123.08
National Average (TC) Fee Submitted 2014: $997.71
National Average (TC) Fee Allowed 2014: $129.46


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 12,681 92.4% $634.73 4,326 34.1%
Gastroenterology 431 3.1% $1272.99 52 12.1%
Independent Diagnostic Testing Facility
(IDTF)
(eff. 6/98)
425 3.1% $1048.64 131 30.8%
Interventional radiology
(eff 5/92)
112 0.8% $902.05 21 18.8%
Nuclear medicine 38 0.3% $485.84 11 28.9%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 7,089 51.6% $905.82 2,412 34.0%
Outpatient hospital 5,931 43.2% $395.27 1,943 32.8%
Inpatient hospital 458 3.3% $410.03 143 31.2%
Ambulatory surgical center 28 0.2% $426.30 9 32.1%
Emergency room - hospital 27 0.2% $399.88 8 29.6%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 7,451 54.3% $378.10 2,664 35.8%
No Modifier 4,598 33.5% $1033.43 1,171 25.5%
TC - Technical Component 1,031 7.5% $997.72 540 52.4%
GA - Advanced Beneficiary Notice (ABN) on File 481 3.5% $830.73 125 26.0%
AQ 67 0.5% $933.82 0 0.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


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All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

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