CPT code 74176: CT abdomen and pelvis without contrast

Key takeaways

CPT code 74176 reports a CT scan of the abdomen and pelvis performed without contrast material.

Oral or rectal contrast on its own still codes as without contrast, so the study stays 74176.

Medicare’s 2026 national non-facility rate for 74176 is roughly $183, before any geographic adjustment.

The final radiology report decides the code, not the order form the practice sent over.

Pair the claim with the most specific diagnosis code the record supports, since unspecified codes invite documentation requests.

CPT code 74176 covers a CT scan of the abdomen and pelvis performed without contrast material. One detail decides whether the claim pays, and that is the contrast documented in the final report. Bill the wrong member of this three-code family and the claim denies, then comes back as rework.

Coders and billing staff also need the 2026 rate, diagnosis codes that hold up, and the right modifier. From here, the sections below follow a 74176 claim from the order through to the remittance.

CPT code 74176 is the no-contrast option in a three-code family

The official descriptor from the American Medical Association (AMA) reads: Computed tomography, abdomen and pelvis; without contrast material(s). The code lives in the diagnostic radiology section of the CPT manual, codes 70010 to 79999.

All three codes in the 74176 to 74178 range cover both regions in one session. Anatomy stays constant across them, so contrast is the only variable that moves the code.

Note on RVU figures: the work RVUs above come from the CMS RVU26C file published in July 2026. CMS revises these values through the year. Check the current relative value files before you build a payment estimate.

Contrast protocol picks the code, not the order form

Miscoding in this family usually starts with a study that changed after the order went in. The technologist gives IV contrast, the requisition still says without, and the coder bills from the requisition.

So work from the report every time. The diagram below turns the report’s contrast language into a single code.

One CPT rule catches people out here. In the radiology section, with contrast means contrast given intravascularly, intra-articularly, or intrathecally. Oral or rectal contrast on its own does not qualify, so a stone protocol with oral prep is still 74176.

Here is how the three codes land once the report is in front of you.

Watch the neighboring codes as well. CPT 74150 and 74160 cover the abdomen alone, without and with contrast. CPT 74170 is the abdomen alone, without contrast then with it. CPT 74175 is a CT angiography study. Reach for 74176 only when both the abdomen and the pelvis were imaged.

Medical necessity is won or lost in the ordering note

The claim stands on the ordering provider’s note. That note has to say why the patient needed imaging, and why the study skipped contrast.

American College of Radiology (ACR) appropriateness criteria put non-contrast CT first in two situations. Contrast is contraindicated, or the clinical question does not need enhancement to answer it.

Scenarios that regularly support a 74176 claim include:

• Suspected kidney stone, where a non-contrast protocol is the standard first look
• Surveillance of an abdominal aortic aneurysm that does not call for contrast
• A known contrast allergy, or renal function below the payer’s threshold
• Follow-up of a known retroperitoneal mass with no need for enhancement
• Calcifications, hemorrhage, or free air suspected in an acute abdomen
• Cancer surveillance where the oncologist’s protocol specifies no contrast

A one-line indication such as “abdominal pain” will not carry a claim through review at most Medicare Administrative Contractors (MACs). Name what the study is ruling out. Then note the reason contrast was withheld, in the ordering provider’s own words.

The diagnosis code has to justify the scan

Diagnosis codes are how a payer sees the medical necessity you documented. The codes below are widely accepted by Medicare and the major commercial plans on 74176 claims.

Coverage still varies by MAC and by local coverage determination (LCD). Check your jurisdiction’s LCD and our ICD-10-CM code reference before the claim goes out.

Specificity does the work here. Payers read an unspecified code as thin justification for imaging, and they lean on that reading hardest on repeat studies.

What Medicare pays for CPT code 74176 in 2026

The 2026 national non-facility rate for 74176 is roughly $183. That figure comes from 5.48 total RVUs at the 2026 conversion factor of $33.4009, per the CMS RVU26C file.

Your own payment will differ. Geographic practice cost index (GPCI) adjustment moves the amount by locality. Confirm your own figure in the CMS fee schedule lookup before you quote a patient.

Where the scan happens changes the rate

Place of service (POS) decides which rate applies, because the cost of the scanner sits with whoever owns it.

A radiologist reading a hospital study bills the professional component with modifier 26. The hospital bills the technical component on its own claim. An imaging center that owns the scanner bills the global service, with no modifier at all.

Documentation that holds up in a post-payment audit

Post-payment audits are where thin documentation gets expensive. The ordering note and the radiologist’s report both have to stand on their own.

A 74176 claim should be backed by these records:

• Ordering provider note: the clinical indication, symptom history, earlier workup, and the reason a non-contrast study was chosen
• Signed order: an order from the treating physician or a qualified non-physician practitioner, naming the region and the protocol
• Radiologist report: the technique, the history as supplied, the findings, and a signed impression
• Technical parameters: scanner settings, which usually live in the imaging system rather than the billing record
• Contraindication note: a short line such as “eGFR 28 ml/min, contrast withheld” when contrast was ruled out

Build these checks into intake and order entry. Rebuilding a justification after a denial costs far more than capturing it while the patient is still in the department.

Modifiers follow whoever owns the scanner

The right modifier depends on which component you are billing. That, in turn, depends on who owns the equipment and who reads the study.

The expensive miss is modifier 26. Bill a hospital read globally and the payer matches your claim against the facility’s technical claim. Both then get flagged as duplicates.

Why 74176 and 74177 can never share a claim

One session gets one code. Billing 74176 with 74177, or 74176 with 74178, is unbundling under the National Correct Coding Initiative (NCCI). The edit catches it every time.

So what if the radiologist ran a non-contrast series and then a contrast series? That study is 74178 on its own. It is never two codes added together.

Modifier 59 will not rescue this pair either. It exists for a separate, distinct service, not for two views of one study.

CMS updates the NCCI tables every quarter. Check the current version before you assume a modifier will bypass an edit.

Where 74176 claims go wrong, and how to catch them first

Denials on this code trace back to a short list of causes. Each one is cheaper to catch before submission than to appeal afterward.

• Wrong contrast code: contrast was given, but the requisition said without and nobody updated it. Code from the final report
• Thin medical necessity: the note never explains why imaging was needed, or why contrast was skipped
• Unbundling: 74176 and 74177 both went out for a single session, so only one of them can stand
• Missing modifier 26: a hospital read billed globally, while the facility billed the technical component
• Unspecified diagnosis: the code on the claim is vaguer than the record supports
• Timely filing: the claim missed the payer’s window. Medicare allows one year from the date of service for most claims

Five checks before you submit

1. Read the final report rather than the order, and confirm what contrast was given
2. Confirm the pelvis was imaged. If it was not, the code is 74150 or 74160
3. Take the most specific diagnosis code the record supports
4. Match the modifier to the setting and to the component you are billing
5. Check the date of service against the payer’s filing window

Those five checks are most of what separates a clean claim from a rework cycle. They take a coder about a minute per study.

How Pabau keeps radiology claims moving

Radiology billing is spread across systems. The order sits in one place, the report in another, and the claim in a third. Coders then re-check contrast, diagnosis, and modifier by hand, which adds minutes to every study.

Practice management software like Pabau pulls those steps into one place. Our claims software for radiology keeps documentation, coding, and submission in one workflow. Each claim gets checked for common edit errors as it is built.

Claims leave through our Claim.MD clearinghouse integration, which reaches thousands of payers, including Medicare, Medicaid, and Blue plans. Remittance advice comes back to the same screen, so a 74176 denial appears beside the claim that caused it.

Reporting by CPT code then shows which studies deny most often. That is how a practice fixes the order-entry step, instead of appealing one imaging claim at a time.

Streamline your radiology billing workflow

Pabau connects coding, documentation, and claim submission in one platform. See how integrated claims management cuts denial rates on imaging codes like CPT code 74176.

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Conclusion

CPT 74176 is a high-volume code with one narrow decision at its center. Read the report, confirm both regions were imaged, and the rest of the claim tends to follow.

Practices that check contrast, diagnosis, and modifier before submission spend far less time in appeals. That habit outlasts any single correction on this page. Rates change every year, and the check still works.

Want to see those checks built into your own workflow? Book a demo and we will walk through how Pabau handles a radiology claim, from the order to the remittance.

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