CPT code 74246 – Double-contrast upper GI examination

Key takeaways

CPT code 74246 reports a double-contrast upper GI exam using high-density barium and an effervescent agent, with glucagon included when given.

CPT 74240 is the single-contrast counterpart, so the contrast technique decides between the two codes, not a KUB film.

Since 2020, scout abdominal radiographs and delayed images are bundled into both codes, and the old with-KUB codes 74241 and 74247 are deleted.

Add-on code +74248 reports a small intestine follow-through done with 74240 or 74246, and it is never billed alone.

Pabau, the practice management platform we build, validates 74246 claims and checks eligibility through Claim.MD before they reach the payer.

CPT code 74246 covers a double-contrast upper GI study

CPT code 74246 is the code for a double-contrast radiologic examination of the upper gastrointestinal tract. The American Medical Association places it in the diagnostic radiology section, and its full official descriptor is in the table below.

In practice, the patient swallows high-density barium and an effervescent agent that releases gas in the stomach. The gas distends the lumen while a thin barium coat outlines the mucosa, so the radiologist sees fine surface detail under fluoroscopy. The study covers the esophagus, stomach, and duodenum.

Two pieces of the descriptor matter most for billing. Scout abdominal radiographs and delayed images are included when performed, so neither changes the code or bills separately. Glucagon, often given to relax the stomach and duodenum, is also included when administered.

What CPT code 74246 includes and excludes

Knowing what the code bundles prevents both undercoding and the unbundling that triggers audits. CPT code 74246 includes the following elements in one billable unit.

• Scout abdominal radiograph(s): The preliminary plain film of the abdomen is part of the code when it is taken. It is not a separate abdominal X-ray charge.
• Double-contrast agents: High-density barium and an effervescent agent are what make the study double contrast.
• Glucagon, when administered: The descriptor folds glucagon into the code, so its use does not change code selection.
• Fluoroscopy and spot images: Real-time imaging and the static images captured during the exam are included.
• Delayed image(s): Later images taken to watch barium transit or gastric emptying are bundled when performed.
• Interpretation and report: These are included in the global service. When billing is split, modifier 26 isolates the professional component.

What 74246 does not cover matters just as much. A small intestine follow-through after the upper GI series is reported with add-on code +74248.

A study limited to the esophagus is an esophagram, reported with 74220 or 74221, while a swallowing function study is 74230. CT of the abdomen or an endoscopy on the same date is coded on its own.

The contrast technique decides 74240 or 74246

CPT 74240 and 74246 share the same stem, so both include scout and delayed images when performed. They differ in one element after the semicolon. That element is the contrast technique. A single-contrast study with barium alone is 74240. A double-contrast study with high-density barium and an effervescent agent is 74246.

The decision rule is simple: Code from the contrast agents the radiology report documents, not from the order. If the report names an effervescent agent with high-density barium, bill 74246. If it describes barium alone, bill CPT code 74240, even when the order asked for an air-contrast study.

A KUB film plays no part in this choice. Under current CPT, a scout image is bundled into both codes. Taking one, or skipping it, never moves a study from one code to the other. The diagram below walks the full choice, from the anatomy studied to the small bowel add-on.

The 2020 revision removed the separate KUB codes

Before 2020, the upper GI family split studies by whether a KUB scout film was taken and whether a small bowel follow-through was added. CPT 2020 rewrote the family and deleted four codes: 74241, 74245, 74247, and 74249. The scout image moved into the base descriptor, and the follow-through became an add-on code.

This is why any reference that still splits 74246 by whether a KUB film was taken is out of date. Current CPT has no separate with-KUB or without-KUB upper GI code. Billing a deleted code returns an invalid-code rejection before the claim is ever reviewed.

Related codes in the pharynx, esophagus, and upper GI family

The codes below sit in the same part of the CPT manual and are often confused with 74246. Each descriptor reflects the 2020 revision and matches the current CMS fee schedule.

Code +74248 deserves particular attention. CMS lists it with a ZZZ global period, the marker for an add-on code, and its descriptor ties it to a primary upper GI exam.

Report it on the same claim as 74246 when the radiologist follows the barium into the small bowel. A small bowel study done without an upper GI exam is 74250, not 74248.

Modifiers for CPT code 74246

CMS assigns 74246 a PC/TC indicator of 1, so it can be billed globally or split into its technical and professional components. The modifier tells the payer which entity performed which part.

The most common modifier error is a split service billed as global. When a hospital or imaging center performs the study and an independent radiologist reads it, both bill 74246. The facility appends TC and the radiologist appends 26. If either omits its modifier, the payer sees two global claims and denies one as a duplicate.

Medicare reimbursement for CPT code 74246

Medicare pays 74246 under the Medicare Physician Fee Schedule. The figures below come from the CMS 2026 PFS relative value file (October release) at the standard conversion factor of $33.4009. They are national amounts before geographic adjustment.

The global value is the work RVU (0.88), the non-facility practice expense RVU (3.09), and the malpractice RVU (0.06). The technical component carries about 69% of the total. Clinicians in a qualifying alternative payment model use the higher $33.5675 conversion factor.

Payment in your locality depends on the Geographic Practice Cost Index, so confirm it with the CMS Physician Fee Schedule lookup tool. Commercial and Medicare Advantage plans set their own rates under each contract. After adjudication, the electronic remittance advice shows the paid amount and any adjustment reason codes.

Prior authorization for CPT code 74246

Traditional Medicare generally does not require prior authorization for a diagnostic upper GI study. Medicare Advantage and commercial plans set their own rules, and those vary by plan. Check the patient’s plan before scheduling, and record the authorization number and the representative’s name.

Run insurance eligibility verification when the study is booked and again before the appointment. Mid-year benefit changes can add an authorization step to a code that did not need one before.

• Documentation for the request: The ordering clinician’s referral, the clinical indication, symptom duration, treatments already tried, and any prior imaging or endoscopy.
• Criteria payers often apply: Symptoms that persist despite empirical treatment, or a presentation that makes endoscopy impractical.
• Peer-to-peer review: If a request is denied on medical necessity grounds, the ordering clinician can usually ask for a peer-to-peer call with the payer’s reviewer.

ICD-10 codes that support medical necessity for CPT 74246

The diagnosis on the claim must justify the upper GI study. Payers match it against their coverage policy, so the codes below are common pairings rather than a guaranteed list. Confirm each pairing’s full descriptor in our ICD-10-CM code library. Check your payer’s policy, because covered diagnoses vary.

Documentation the radiology report needs for CPT 74246

A complete radiology report is the base of a defensible 74246 claim. On audit, the report must prove that the study was double contrast. It should include the elements below.

• Ordering clinician and indication: The name, NPI, and clinical reason from the referral. Without them, the medical necessity link breaks.
• Contrast agents used: High-density barium and the effervescent agent, named explicitly. This element alone separates a 74246 from a 74240 on audit.
• Glucagon, if given: The dose and route. It does not change the code, but it supports the double-contrast technique.
• Fluoroscopic technique: Patient positions, such as upright, supine, prone, and oblique, plus any maneuvers used to assess reflux.
• Structures imaged: Findings for the esophagus, stomach, and duodenum, including mucosa, folds, and the duodenal bulb.
• Scout and delayed images, when taken: Note them for completeness. They are bundled, so they never justify a second code.
• Small bowel follow-through, if done: Serial images of the small intestine and the time span covered, to support +74248.
• Signed interpretation: A signed, dated impression that connects to the ICD-10 code billed. A normal study is a valid finding, but an unsigned report is not billable.

Common denial reasons for CPT code 74246 and how to prevent them

Denials for 74246 cluster around a few predictable causes, and each has a documentation fix. Track claim adjustment reason codes by CPT code in your denial management workflow to see which one costs your practice most.

• Technique not documented: The claim says 74246, but the report never names the effervescent agent. Prevention: Add a required contrast-technique field to the report template.
• Wrong code for the technique: A barium-only study is billed as 74246, or a double-contrast study as 74240. Prevention: Code from the final report, never from the order.
• Deleted codes or an unbundled scout film: A claim uses 74247 or 74249, or adds a separate abdominal X-ray for the scout image. Prevention: Retire the pre-2020 codes in your charge master.
• Add-on billed incorrectly: +74248 appears without 74240 or 74246, or alongside a standalone small bowel study. Prevention: Set a claim edit that requires a primary upper GI code with every 74248.
• Diagnosis does not support necessity: The ICD-10 code does not map to the payer’s covered indications. Prevention: Check the pairing against the payer policy before submission.
• TC and 26 split conflict: Both entities bill globally, or neither appends its modifier. Prevention: Agree on billing roles between the radiology group and the facility when you contract.
• Unresolved bundling edits: Some same-day imaging combinations hit procedure-to-procedure edits. Prevention: Check pairs against the CMS NCCI edit tables before you submit.

How claims management software protects CPT code 74246 claims

Most denials on 74246 start before the claim leaves the practice. A coder picks the code from the order, or a deleted code lingers in an old fee sheet. Sometimes a modifier goes missing on a split service. Catching those by hand means rereading every report against every claim.

Pabau’s claims management software moves that check upstream. Claims go out as electronic claims via Claim.MD, which scrubs code and modifier combinations and returns eligibility data before submission. A superbill template that mirrors the documentation checklist above keeps the billing team and the radiology department working from the same record.

The result is fewer technique and modifier denials, and a clean claim rate you can track by CPT code.

Catch 74246 coding errors before payers do

Pabau validates upper GI claims through Claim.MD, checks eligibility before the study, and surfaces denial reason codes by CPT code. See how it works for radiology and gastroenterology practices.

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Conclusion

CPT code 74246 turns on one question: Did the study use double contrast? If the report names high-density barium and an effervescent agent, the code is 74246. If it describes barium alone, the code is 74240. A KUB film no longer moves the code either way.

The practices that get paid cleanly on this code retire the pre-2020 codes and code from the final report. They also bill 74248 only beside its primary code. That discipline costs a few minutes per claim and removes the most common reasons for denial.

Book a demo to see how Pabau keeps GI radiology claims accurate from the report to the remittance.

Continue your research

Need to understand how clearinghouse claim validation works? Medical claims clearinghouse overview explains how claims are scrubbed, validated, and routed to payers before adjudication.

Tracking denial reason codes across your GI radiology portfolio? Denial codes in medical billing maps CARC and RARC codes to their prevention strategies.

Looking for the 74246 billing context within revenue cycle management? Revenue cycle management explained covers the end-to-end process from eligibility check through ERA posting.

Billing a barium-only upper GI study? CPT code 74240 covers the single-contrast counterpart, with its own RVUs and documentation rules.

Was the study a dynamic swallow rather than an upper GI? CPT code 74230 explains how to code a swallowing function study with cineradiography.

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