Which payers have published criteria for CT abdomen and pelvis with contrast (CPT 74177)?

The imaging guidelines used by Aetna, Anthem BCBS, Cigna, Medicare, UnitedHealthcare include criteria that apply to this study. Whether a specific patient's plan requires prior authorization depends on the plan, so confirm on the payer's portal or by phone before scheduling.

Who reviews prior authorization requests for CT abdomen and pelvis with contrast (CPT 74177)?

Most commercial payers hand imaging reviews to a radiology benefit manager. For the payers tracked here, requests are reviewed using guidelines from eviCore, Carelon, CMS, UnitedHealthcare / eviCore. The request is submitted through that organization's portal rather than the health plan's general line.

What should be in the clinical notes before requesting CT abdomen and pelvis with contrast (CPT 74177)?

Reviewers look for a recent office visit that documents the symptoms and how long they have lasted, exam findings, results of any earlier imaging, treatments already tried and how the patient responded, and the specific question the study is expected to answer. The diagnosis code on the request should match what the notes describe.

How much does CT abdomen and pelvis with contrast (CPT 74177) cost?

Across 1,095 hospitals that publish their negotiated rates, the median commercial insurance rate is $1,335, with the middle half of rates between $610 and $2,925. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if CT abdomen and pelvis with contrast (CPT 74177) is denied?

Read the denial letter for the stated reason, then request a peer-to-peer conversation between the ordering clinician and the reviewing physician, which often resolves missing-information denials. If that fails, file a written appeal that answers the stated reason directly and attach the supporting notes. The denial letter lists the deadline and where to send the appeal.

CPT 74177: CT abdomen and pelvis with contrast - Prior Authorization and Price

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CPT 74177

CT imaging of the abdomen and pelvis using contrast dye.

CT Abdomen & Pelvis

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Abdomen Imaging Guidelines 2.0.2026, effective Sep 1, 2026	216 that name this code
Anthem BCBS	Carelon	Imaging of the abdomen and pelvis effective Apr 4, 2026 Oncologic imaging effective Apr 4, 2026 Advanced imaging for vascular indications effective Sep 19, 2026	102 that name this code
Cigna	eviCore	Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Abdomen Imaging Guidelines 2.0.2026, effective Sep 1, 2026	223 that name this code
Medicare	CMS	NCD 220.1: Computed Tomography effective Mar 12, 2008	1 that name this code
Original Medicare does not run a prior authorization program for outpatient imaging; claims are judged against the coverage policies above. Medicare Advantage plans set their own prior authorization rules.
UnitedHealthcare	UnitedHealthcare / eviCore	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	215 that name this code

Guidelines collected from the payers' published documents on September 29, 2026. Payers revise these documents during the year. Open the guideline link to confirm the current version before you submit.

Conditions the guidelines address for this study

These are the clinical situations where payer guidelines discuss CT abdomen and pelvis with contrast. Each has its own criteria for when the study is considered appropriate.

Neuroendocrine Cancers and Adrenal Tumors Aetna · Cigna · UnitedHealthcare
Non-Hodgkin Lymphomas Aetna · Cigna · UnitedHealthcare
Upper GI Cancers Aetna · Cigna · UnitedHealthcare
Melanomas and Other Skin Cancers Aetna · Cigna · UnitedHealthcare
Metastatic Cancer, Carcinoma of Unknown Primary Site, and Other Types of Cancer Aetna · Cigna · UnitedHealthcare
Anal Cancer & Cancers of the External Genitalia Aetna · Cigna · UnitedHealthcare
Colorectal and Small Bowel Cancer Aetna · Cigna · UnitedHealthcare
Uterine Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Ovarian Cancer Aetna · Cigna · UnitedHealthcare
Sarcomas – Bone, Soft Tissue, and GIST Aetna · Cigna · UnitedHealthcare
Testicular, Ovarian and Extragonadal Germ Cell Tumors Aetna · Cigna · UnitedHealthcare
Cervical Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Breast Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Pancreatic Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Thyroid Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Hodgkin Lymphoma Aetna · Cigna · UnitedHealthcare
Medical Conditions with Cancer in the Differential Diagnosis Aetna · Cigna · UnitedHealthcare
Small Cell Lung Cancer Aetna · Cigna · UnitedHealthcare
Prostate Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Other Thoracic Tumors Aetna · Cigna · UnitedHealthcare
Esophageal and GE Junction Cancer Aetna · Cigna · UnitedHealthcare
Renal Cell Cancer (RCC) Aetna · Cigna · UnitedHealthcare
Transitional Cell Cancer Aetna · Cigna · UnitedHealthcare
Multiple Myeloma and Plasmacytomas Aetna · Cigna · UnitedHealthcare
Leukemias, Myelodysplasia and Myeloproliferative Neoplasms Aetna · Cigna · UnitedHealthcare
Non-Small Cell Lung Cancer Aetna · Cigna · UnitedHealthcare
Primary Central Nervous System Tumors Aetna · Cigna · UnitedHealthcare
Pediatric Renal Tumors Aetna · Cigna · UnitedHealthcare
Diarrhea, Constipation, and Irritable Bowel Aetna · Cigna · UnitedHealthcare
Bowel Obstruction, Gastroparesis, and Bloating Aetna · Cigna · UnitedHealthcare
Pancreatitis Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Abdominal Mass Aetna · Cigna · UnitedHealthcare
Histiocytic Disorders Aetna · Cigna · UnitedHealthcare
Neuroblastoma Aetna · Cigna · UnitedHealthcare
Pediatric Liver and Pancreatic Tumors Aetna · Cigna · UnitedHealthcare
Pediatric Lymphomas Aetna · Cigna · UnitedHealthcare
Transplant Aetna · Cigna · UnitedHealthcare
Abdominal Pain Aetna · Cigna · UnitedHealthcare
Bariatric Surgery and Percutaneous Gastrostomy Aetna · Cigna · UnitedHealthcare
Bone Tumors Aetna · Cigna · UnitedHealthcare

Plus 138 more. Use the search below to find a specific condition.

Typical price

Commercial insurance, median

$1,335

Middle half of rates: $610 to $2,925

Medicare, hospital outpatient

$356

Facility payment

Medicare, physician fee schedule

$302

National, non-facility

Commercial figures come from negotiated rates published by 1,095 hospitals; Medicare figures from CMS fee schedules. Rates vary widely by hospital and plan. Pricing data from CenterIQ.

Get notified when the rules for this study change

Payers update imaging guidelines several times a year. We will email you when the criteria for CT abdomen and pelvis with contrast change.

CPT 74177: CT abdomen and pelvis with contrast - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

Imaging CPT Code Coverage Lookup

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CT

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CPT 74177: CT abdomen and pelvis with contrast - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

Related studies

Imaging CPT Code Coverage Lookup

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET