Which payers have published criteria for CT colonography, diagnostic, without contrast (CPT 74261)?

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 colonography, diagnostic, without contrast (CPT 74261)?

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 colonography, diagnostic, without contrast (CPT 74261)?

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.

CPT 74261: CT colonography, diagnostic, without contrast - Prior Authorization and Price

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CPT 74261

CT imaging of the large intestine performed without using contrast dye.

CT Abdomen & Pelvis

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026	2 that name this code
Anthem BCBS	Carelon	Oncologic imaging effective Apr 4, 2026	4 that name this code
Cigna	eviCore	Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026	2 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	2 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 colonography, diagnostic, without contrast. Each has its own criteria for when the study is considered appropriate.

CT Colonography (CTC) Aetna · Cigna · UnitedHealthcare
Cancer screening, not otherwise specified Anthem BCBS
Colorectal cancer screening Anthem BCBS
Computed Tomography Medicare
Histiocytic Neoplasms Anthem BCBS
Neuroendocrine Tumors Anthem BCBS

Typical price

Commercial insurance, median

$436

Middle half of rates: $212 to $971

Medicare, hospital outpatient

$107

Facility payment

Medicare, physician fee schedule

$411

National, non-facility

Commercial figures come from negotiated rates published by 593 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 colonography, diagnostic, without contrast change.

CPT 74261: CT colonography, diagnostic, without 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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CPT 74261: CT colonography, diagnostic, without 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