CPT 74221
Global XXX ActiveX-ray xm esophagus 2cntrst
CPT 74221 Billing & Documentation Guide
CPT code 74221 (X-ray xm esophagus 2cntrst) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.68, a non-facility practice expense RVU of 2.43, and a malpractice RVU of 0.05, a total non-facility RVU of 3.16 and facility RVU of 3.16. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $109.31, though rates vary from $93.29 to $143.14 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 74221, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 74221 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 74221 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 74221
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.68 | 0.68 |
| Practice Expense RVU | 2.43 | 2.43 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 3.16 | 3.16 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 74221
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $120.47 | $120.47 | $112.95 - $143.14 | 29 |
| Florida | $107.4 | $107.4 | $102.82 - $111.43 | 3 |
| Georgia | $102.18 | $102.18 | $97.1 - $107.25 | 2 |
| Illinois | $104.41 | $104.41 | $99.43 - $109.19 | 4 |
| Michigan | $101.28 | $101.28 | $98.7 - $103.85 | 2 |
| North Carolina | $99.51 | $99.51 | $99.51 - $99.51 | 1 |
| New York | $116.61 | $116.61 | $100.99 - $123.77 | 5 |
| Ohio | $98.5 | $98.5 | $98.5 - $98.5 | 1 |
| Pennsylvania | $104.21 | $104.21 | $98.8 - $109.61 | 2 |
| Texas | $104.3 | $104.3 | $98.12 - $110.11 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 74221
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 74221 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 74210 | Column 1 (primary), can be billed with modifier | Yes | HCPCS/CPT procedure code definition |
| 74220 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 74248 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 76000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 77001 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 77002 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 74230 | Column 2 (secondary), bundled into primary | No | More extensive procedure |
Frequently Asked Questions, CPT 74221
What does CPT code 74221 mean? +
CPT code 74221 represents: X-ray xm esophagus 2cntrst. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 74221? +
The 2026 Medicare national average non-facility payment for CPT 74221 is $109.31. Rates range from $93.29 to $143.14 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 74221? +
Radiology codes rely heavily on the professional/technical split: modifier 26 (professional component only) and TC (technical component only). Also common: 50 (bilateral imaging), 76 (repeat by same physician), 77 (repeat by different physician), and LT/RT for laterality.
What bundling edits apply to CPT 74221? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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