CPT code 74178 is used for combined CT scans of the abdomen and pelvis that include both non-contrast and IV-contrast phases. In 2025, understanding this code is more important than ever due to updates from the AMA and Medicare. This guide explains when and how to use CPT 74178, key 2025 changes, documentation tips, and billing best practices for accurate claims submission.
What Is CPT 74178?
CPT 74178 represents a CT scan of the abdomen and pelvis performed without IV contrast first, followed by a second phase with IV contrast. According to the AAPC, this code applies when the provider completes both imaging phases during the same session. It’s commonly used for cases involving abdominal pain, trauma, or cancer assessment, where both contrast and non-contrast views are necessary.
To distinguish CPT 74178 from similar codes:
- 74176: CT abdomen/pelvis without contrast only
- 74177: CT abdomen/pelvis with contrast only
Learn more about choosing the right code in our CT Abdomen/Pelvis CPT code guide.
2025 CPT Updates for 74178
Effective January 1, 2025, the official CPT descriptor for 74178 has been updated for clarity. The revised description now explicitly states that the code includes both non-contrast and contrast imaging phases. This helps avoid confusion and aligns with payer policies from organizations like UnitedHealthcare and CMS.
Coders should also watch for changes in:
- Relative Value Units (RVUs)
- OPPS APC assignments
- Medicare local coverage determinations (LCDs)
For Medicare-specific policies, consult the Medicare Coverage Database.
Proper Documentation and Medical Necessity
To bill CPT 74178 correctly, ensure documentation supports the dual-phase CT scan. Acceptable indications include:
- Persistent abdominal or pelvic pain
- Suspected trauma or internal bleeding
- Evaluation of masses, tumors, or post-surgical complications
- Hematuria or renal pathologies
The radiology order and clinical notes should clearly outline the reason for both phases. Use the most accurate and up-to-date ICD-10 codes to support medical necessity. Visit our CMS-1500 claim form example for coding guidance.
Billing and Coding Best Practices
- Use only CPT 74178 for a combined non-contrast and contrast study—do not report 74176 or 74177 with it.
- Do not bill contrast separately; it’s included in 74178.
- Watch for NCCI edits: Avoid billing single-region CT codes alongside 74178 unless there’s a distinct, separate study with modifier 59.
- Apply proper modifiers such as 26 (professional component), TC (technical component), or 59 when applicable.
- Ensure clean claim submission: Confirm correct diagnosis pointers, service dates, and modifiers on the CMS-1500 form.
Explore our CMS-1500 claim form instructions for detailed box-by-box tips.
Related CT Codes to Know
- 74176: Abdomen/pelvis without contrast
- 74177: Abdomen/pelvis with contrast
- 74150–74170: Abdomen-only CT codes
- 72192–72194: Pelvis-only CT codes
Never mix these codes with 74178 unless they represent entirely separate studies. For scenarios and walkthroughs, see our contrast CT coding breakdown.
FAQs
When should I report CPT 74178?
Report CPT 74178 when a CT of the abdomen and pelvis includes both non-contrast and contrast imaging during the same session.
Can I bill separately for IV contrast?
No. The contrast injection is bundled into CPT 74178. Separate billing is not permitted for most payers.
How does 74178 differ from 74177?
74177 includes contrast imaging only. Use 74178 when a non-contrast phase precedes the contrast scan.
Can I report abdomen or pelvis-only codes with 74178?
Generally, no. Only bill them separately if the scans are done during different encounters with medical necessity and modifier 59.
Conclusion
CPT 74178 is essential for billing dual-phase CT scans of the abdomen and pelvis in 2025. To avoid denials and ensure compliance, coders must understand its definition, documentation requirements, and payer-specific rules. As always, stay current with CPT revisions and ICD-10 updates to bill with confidence and accuracy.