Radiology Billing Services

Radiology billing starts with one question: who owns the equipment and who reads the study? The answer decides whether a claim is billed globally, or split into a professional component (the physician's interpretation) and a technical component (the equipment, staff, and supplies). Get it wrong and the claim is denied or paid to the wrong party.

Diagnostic radiology groups also deal with multiple-study reductions, prior authorization for advanced imaging, and contracts with several hospitals. Westmont Revenue Partners connects radiology groups with vetted billing experts who know radiology medical billing and can support the whole revenue cycle.

Who this is for

• Private radiology groups that read for hospitals and imaging centers
• Radiologists employed by hospitals who need clean professional claims
• Groups that own equipment and bill globally
• Practices with subspecialty readers in breast, neuro, or body imaging
• Owners comparing in-house billing with outsourced radiology billing

What gets billed

• Professional interpretation of X-ray, CT, MRI, and ultrasound studies
• Technical component for studies done on owned equipment
• Global billing when one entity owns the equipment and reads the study
• Screening and diagnostic mammography
• Low-dose CT lung cancer screening
• PET and PET/CT imaging
• Contrast and supply charges where payable
• Second opinion and over-read services
• Imaging-guided procedures performed by radiologists
• Add-on and bilateral service reporting

Commonly billed codes

Code	Type	What it covers
70553	CPT	MRI of the brain without then with contrast
72148	CPT	MRI of the lower spine without contrast
71271	CPT	Low-dose CT for lung cancer screening
77067	CPT	Screening mammography, both breasts, with computer-aided detection
78815	CPT	PET with CT, skull base to mid-thigh
78816	CPT	PET with CT, whole body
26	Modifier	Professional component only: the physician's interpretation and report
TC	Modifier	Technical component only: equipment, technologist, and supplies

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in radiology

Professional vs. technical component billing. Many imaging codes can be billed three ways.

• Global (no modifier). One entity owns the equipment and interprets the study. This is common in freestanding imaging centers and some office settings.
• Professional component (modifier 26). The radiologist bills only for reading the study and writing the report. This is typical in hospitals.
• Technical component (modifier TC). The facility or equipment owner bills for the scan itself.

Place of service matters. In a hospital setting, the hospital usually bills the technical side and the radiologist bills the professional side. Billing global from a facility setting can trigger denials. A biller checks ownership, contracts, and the site of service on every claim.

• Global versus split billing. A single wrong modifier can cause a denial or a double payment. Billers check who owns the equipment and who read the study before they choose.
• Multiple imaging reductions. Medicare generally reduces payment when several imaging studies are done in one session, for both the technical and professional sides. Billers model these cuts so payments are not flagged as errors.
• Prior authorization for advanced imaging. Many payers require approval for CT, MRI, and PET. Responsibility often falls on the ordering provider, but radiology groups face denials too. Billers track authorization numbers on claims.
• Medicare appropriate use criteria. The Medicare AUC program was rescinded in recent rulemaking. Billers remove old AUC reporting from templates and watch current-year rules.
• Missing order and clinical information. A study without a valid order or reason for the exam can be denied. Billers flag missing orders before claims leave the system.
• Contrast and supply billing. Contrast is billed separately by some payers and bundled by others. Billers set payer rules in the claim system.
• Hospital contracts and splitting revenue. Groups serving several facilities need clear rules on who bills what. Billers keep a contract matrix by site.

How Westmont can help

• Matching you with vetted billing experts experienced in diagnostic radiology
• End-to-end revenue cycle support, from charge capture to payment posting
• Denial management, including authorization and modifier denials
• Credentialing and payer enrollment for radiologists and groups
• Reporting that separates professional and technical revenue

Frequently asked questions

What does modifier 26 mean in radiology billing?

Modifier 26 marks the professional component of a service. It tells the payer that the physician provided the interpretation and report but did not own the equipment. Radiologists working in hospitals bill with this modifier. The facility bills the technical side, often through its own claim.

When can a practice bill globally for imaging?

A practice can generally bill globally when it owns or leases the equipment, employs the technologist, and the same entity interprets the study. If a different group reads the images, the claim must be split into two components. Check payer contracts and enrollment first.

What is the TC modifier used for?

TC marks the technical component, which covers the equipment, technologist, supplies, and overhead. Imaging centers use it when a different party interprets the study. Hospital outpatient technical services are billed on facility claims instead of with this modifier.

Does Medicare still require appropriate use criteria for advanced imaging?

CMS paused the program and later rescinded the regulations, so there is currently no consultation or reporting requirement. Rules can change, so confirm in the current-year fee schedule rule. Also remove retired AUC codes and modifiers from your templates.

Why are our radiology claims paid at less than the fee schedule?

Multiple-study reductions are a common cause. Medicare generally pays full price for the highest-valued advanced imaging study and reduces the others in the same session. Payers may use their own formulas. A biller can compare each payment to the contract.

Related billing services

• Interventional Radiology Billing
• Teleradiology Billing
• Imaging Center Billing
• Nuclear Medicine Billing
• Radiation Oncology Billing
• Hospital Billing