CT of the abdomen and pelvis together with IV contrast, commonly used in trauma and infection workups, including fevers and abscess concerns after orthopedic or spine surgery.
- Medicare
- $300.27
- Work RVU
- 1.77
- Global, days
- Region
- Other
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Clinical reason (trauma, postoperative fever, abscess, metastatic workup)
- Contrast agent and dose
- Regions covered
- Signed interpretation
- Authorization for outpatient studies when required
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
Contrast-enhanced CT of the abdomen and pelvis together is 74177. It is a staple of trauma imaging, and in ortho it appears in polytrauma with pelvic ring injuries, postoperative fever after spine fusion, psoas or paraspinal abscess workups, and metastatic workup when a pathologic fracture is the first sign of cancer.
Use one combined code when both regions are scanned. Do not bill 74160 and 72193 for the same session, and do not add 72192 to 72194 for a dedicated pelvis CT on top of 74177 from the same acquisition. If the pelvis fracture service wants thin-cut bone reformats from the trauma scan, those are generally part of the original study. A separately acquired dedicated pelvis CT is a different exam and needs its own order and report.
If a non-contrast series was also acquired and read, the code is 74178, not 74177. Commercial plans often require authorization for outpatient studies but not for emergency department scans. Use modifier 26 for the professional read in a hospital.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (1.77) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (8.99) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.77 |
| Practice expense RVU | 7.09 |
| Malpractice RVU | 0.13 |
| Total RVU | 8.99 |
| Medicare national rate | $300.27 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $300.27 |
HOPD (APC 5572) Hospital outpatient department | $356.43 |
Common denial reasons
The recurring reasons claims for CPT 74177 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Separate abdomen and pelvis codes billed instead of the combined code
- Billed with 72193 from the same acquisition
- Non-contrast phase also read, so 74178 was correct
- Outpatient study missing authorization
- Missing 26 modifier on hospital-based read
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Can 74177 and 72193 be billed together?
02Are pelvic reformats from a trauma CT billed separately?
03When do I use 74178 instead of 74177?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes document the fever, wound findings, or injury pattern behind the scan, so a contrast abdomen and pelvis CT ordered by an orthopedic team is supported.
See how Mira captures CPT 74177 documentation