2025 CPT code 74221
(Active) Effective Date: N/A Revision Date: N/A Diagnostic Radiology - Esophagus Radiology Feed
Double-contrast radiologic examination of the esophagus, including scout chest radiograph(s) and delayed image(s), when performed.
Modifiers 26 (professional component) and TC (technical component) may be appended as appropriate, but not when the procedure is a global service.Other modifiers may apply depending on the circumstances.
Medical necessity for a double-contrast esophagram is established based on the patient's clinical presentation, symptoms (e.g., dysphagia, odynophagia), and/or prior imaging findings suggestive of esophageal pathology.Appropriate documentation supporting the medical necessity is crucial for reimbursement.
The clinical responsibility includes patient positioning, administration of contrast agents (barium sulfate and effervescent agent), image acquisition (including fluoroscopy if used), image interpretation, and generation of a detailed written report documenting findings and conclusions.
In simple words: This test uses a special X-ray with a barium drink and gas-producing tablets to get detailed pictures of the esophagus (the tube that connects your mouth to your stomach). The doctor watches the barium move through your esophagus on a screen and takes pictures before and after the barium is swallowed to check for any problems.
This CPT code encompasses a double-contrast radiologic examination of the esophagus using high-density barium and an effervescent agent. The procedure includes scout films (plain X-rays of the chest) prior to barium ingestion and delayed films following barium ingestion, when performed.The radiologist positions the patient, administers the contrast agents, acquires the images using fluoroscopy as needed, and interprets the results, generating a comprehensive report detailing findings such as narrowing, blockages, enlarged veins, or other structural or functional anomalies. Fluoroscopy, live X-ray imaging, may be used to visualize the barium's transit through the esophagus.
Example 1: A 60-year-old male patient presents with complaints of dysphagia (difficulty swallowing). A double-contrast esophagram (74221) is performed to evaluate for esophageal strictures, diverticula, or tumors., A 35-year-old female patient with a history of GERD (gastroesophageal reflux disease) undergoes a double-contrast esophagram (74221) to assess for esophageal inflammation or Barrett's esophagus., A 72-year-old male patient post-esophagectomy requires a double-contrast esophagram (74221) to evaluate the patency and integrity of the esophageal anastomosis.
* Patient demographics and medical history.* Indication for the procedure (e.g., dysphagia, GERD, post-surgical evaluation).* Radiologic images (scout films, barium swallow images, delayed images).* Fluoroscopy report if used.* Radiologist's interpretation and report detailing findings.
** The use of fluoroscopy is at the discretion of the radiologist based on clinical need.The report should clearly indicate the use and findings from fluoroscopy if performed.High-density barium is generally used but other contrast agents may be utilized.
- Revenue Code: I1D (STANDARD IMAGING - CONTRAST GASTROINTESTINAL)
- Payment Status: Active
- Modifier TC rule: Modifier TC applies when only the technical component is reported.
- Specialties:Radiology, Gastroenterology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center