CodeMap® Report 74261
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2017-A PEN Fee Schedule-no changes for rest of 2017     


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74260
Quick jump to procedure code: Printer Friendly Version
74262

74261: Ct colonography dx

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


Short Description: Ct colonography dx

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CPT copyright 2016 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2017 Physician
Fee Schedule:

Global Fee $492.75
* 26 Modifier $123.46
* TC Modifier $369.29

2017 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2017 October Unadjusted OPPS Payment $112.73


*Based on National 2013 Medicare Part B submitted claims.
2017 APC Code: 5522
Level 2 Imaging without Contrast

Composite APC: 8005
CT and CTA without Contrast Composite

2017 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.
Percentage
ICD-10 Code
Description
Related DRG(s)
19.3%
K57.30
Diverticulosis of large intestine without perforation or abscess without bleeding
391-392
17.5%
Z53.8
Procedure and treatment not carried out for other reasons
795
951
5.3%
K63.5
Polyp of colon
393-395
5.3%
R10.9
Unspecified abdominal pain
391-392
4.4%
K59.00
Constipation, unspecified
391-392
4.4%
K5669
This diagnosis code is no longer active.
388-390
793
2.6%
Q43.8
Other specified congenital malformations of intestine
393-395
2.6%
Z12.11
Encounter for screening for malignant neoplasm of colon
951
2.6%
K44.9
Diaphragmatic hernia without obstruction or gangrene
391-392
1.8%
K57.90
Diverticulosis of intestine, part unspecified, without perforation or abscess without bleeding
391-392

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

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.

Column 1 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
(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.



Column 2 CCI Edits for 74261
Denied Codes (1) Effective Modifier
Accepted (2)
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 121
MARK CARTER -JACKSONVILLE,FL 120
AMY PATRICK -NEWARK,DE 115
ALEC MEGIBOW -NEW YORK,NY 109
AMARNATH SORTUR -NEWARK,DE 89

   74261 Top 5 Ordering Organizations National*
ADVANCED IMAGING CENTER, LLC-IL 30
WINCHESTER OPEN MRI LLC-VA 28
BUFORD ROAD IMAGING LLC-VA 22
NORTH FLORIDA OUTPATIENT IMAGING-FL 21
SAINT BARNABAS OUTPATIENT CENTERS-NJ 20

*Based on 2015 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 2016: 14,069
Total Services Denied 2016: 4,705 (33.4%)
National Charges Submitted 2016: $ 9,682,864.35
National Charges Allowed 2016: $ 1,607,998.99
National Average (No Modifier) Fee Submitted 2016: $994.40
National Average (No Modifier) Fee Allowed 2016: $243.48
National Average (26) Fee Submitted 2016: $412.77
National Average (26) Fee Allowed 2016: $124.38
National Average (TC) Fee Submitted 2016: $1300.27
National Average (TC) Fee Allowed 2016: $120.32


Top 5 Performing Specialties 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 13,272 94.3% $667.54 4,519 34.0%
Independent Diagnostic Testing Facility
(IDTF)
(eff. 6/98)
267 1.9% $1344.79 59 22.1%
Gastroenterology 249 1.8% $850.58 39 15.7%
Interventional radiology
(eff 5/92)
181 1.3% $966.03 40 22.1%
Nuclear medicine 40 0.3% $758.78 27 67.5%

Top 5 Places of Service 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 7,229 51.4% $944.76 2,420 33.5%
Outpatient hospital 5,594 39.8% $395.53 1,825 32.6%
Inpatient hospital 408 2.9% $408.53 142 34.8%
Independent Clinic 97 0.7% $1279.84 27 27.8%

Top 5 Modifiers Submitted 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 7,827 55.6% $412.77 2,836 36.2%
No Modifier 4,171 29.6% $994.40 1,137 27.3%
TC - Technical Component 1,065 7.6% $1300.27 421 39.5%
GA - Advanced Beneficiary Notice (ABN) on File 648 4.6% $833.34 151 23.3%
CT 229 1.6% $1022.42 94 41.0%

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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