CPT® 74177; Computed tomography, abdomen and pelvis; with contrast material(s) - JE Part B
CPT® 74177; Computed tomography, abdomen and pelvis; with contrast material(s)
In order to fulfill its contractual obligation with CMS, Noridian Healthcare Solutions (Noridian), your Medicare Contractor, performs pre-payment reviews in accordance with CMS direction. CMS is required by the Social Security Act to ensure that payment is made only for those medical services that are reasonable and necessary. Medical review assesses submitted documentation to validate provider compliance with Medicare payment rules and regulations, including coverage, coding and billing guidelines.
This is to update providers of the claim review findings for CPT® 74177; Computed tomography, abdomen and pelvis; with contrast material(s). The results of this focused review are not a reflection on providers' competence as a health care professional or the quality of care provided to patients. Specifically, the results are based on the documentation requested by Medicare and/or your facility's compliance with the required documentation.
The Jurisdiction E, Part B Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of CPT® 74177; Computed tomography, abdomen and pelvis; with contrast material(s). The quarterly edit effectiveness results from July 1, 2025, through September 30, 2025, are as follows:
Top Denial Reasons
- Denial Reason 1: The requested records were not received.
- Denial Reason 2: The documentation submitted was incomplete and/or insufficient
- Denial Reason 3: The documentation submitted does not support medical necessity as listed in coverage requirements in the National Coverage Determination or Local Coverage Determination
Educational Resources
- Failure to Return Records
- Documentation Requests: How, Who and When to Send
- NCD 220.1 - Computed Tomography
Education
Computed tomography directs multiple thin beams of x-rays at the body structure being studied and uses computer imaging to produce thin, cross-sectional views of various layers of the body. It is useful for the evaluation of trauma, tumor, and foreign bodies as CT can visualize soft tissue as well as bones. These codes report examination of the abdomen and pelvis. A contrast medium may be administered for image enhancement. Documentation submitted must support medical necessity for the procedure.
Report appropriate Healthcare Common Procedure Coding System (HCPCS) code for administered contrast media, if applicable. Report 74176 if no contrast is used; 74177 if performed with contrast; and 74178 if performed first without contrast in one or both body regions followed by the injection of contrast and further sections in one or both body regions. These codes are only reported once per CT abdomen and pelvis examination. These codes report a global code supporting the technical and professional component. Append modifier 26 to report only the professional component or TC modifier to report only the technical component.
National Coverage Determination (NCD) 220.1 provides coverage criteria for computed tomography (CT). Per the NCD, documentation must clearly support the CT scan was medically necessary for the individual beneficiary taking into consideration their symptoms and potential diagnosis.
