Radiology billing
Radiology billing services
We handle billing for radiology groups and imaging centers, from professional reads with modifier 26 to global and technical claims for in-office imaging. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and billing starts at 2.5% of collections.
- Professional, technical and global billing matched to who owns the equipment
- Contrast and view counts coded from the final report
- Prior authorization and ordering provider checked before submission
Why radiology billing is different
Radiology is high volume and split by component
A radiology claim depends on who owns the equipment, what the report says and whether the order was authorized. Radiologists rarely see the patient, so the paperwork has to be right.
Professional vs technical component
The interpretation is billed with modifier 26 and the equipment and staff side with modifier TC. When one entity does both, the global code is billed with no modifier. Billing the wrong split causes duplicate or partial denials.
Contrast and view counts
CT and MRI codes change with contrast: without, with, or without and then with. X-ray codes change with the number of views. The code has to match the final signed report, not the order.
Prior authorization
Advanced imaging like CT, MRI and PET often needs authorization, frequently through a radiology benefit manager. The authorized CPT code must match what was performed, or the claim is denied.
Ordering provider details
Imaging claims need the ordering or referring provider’s name and NPI. For Medicare, that provider must also be enrolled. Missing or mismatched details are a common rejection.
Medical necessity
The diagnosis from the order and report has to support the study under the payer’s coverage policy. Screening and diagnostic studies, like mammograms, are coded and covered differently.
Multiple procedure reductions
When several advanced imaging studies are done in one session, payers reduce payment on the extra studies. We make sure studies are ordered on the claim correctly and payments are checked against the rules.
Common codes
Radiology codes we review before every claim
| Code(s) | What it is | What we watch for |
|---|---|---|
| 71045–71048 | Chest X-ray by number of views | View count matches the report |
| 70450 / 70460 / 70470 | CT head without, with, or without and with contrast | Contrast documented; authorization matches the code billed |
| 70551 / 70552 / 70553 | MRI brain without, with, or without and with contrast | Contrast documented; prior auth and medical necessity |
| 74176 / 74177 / 74178 | CT abdomen and pelvis combined, by contrast | Not billed as separate abdomen and pelvis codes |
| 76700 / 76705 | Abdominal ultrasound, complete or limited | Complete study requires all listed organs to be documented |
| 77065–77067 / 77063 | Diagnostic and screening mammography; screening tomosynthesis add-on | Screening vs diagnostic status and payer frequency rules |
| Modifiers 26 / TC | Professional and technical components | Who owns the equipment and who reads the study |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
The radiology denials we stop before they happen
Most radiology denials are front-end problems: authorization, ordering provider or a code that does not match the report. We catch them before the claim goes out.
- Authorization on file for a different CPT code than the one performed, such as with vs without contrast
- Missing or unenrolled ordering provider name and NPI
- Global claim billed when the hospital or another entity billed the technical component
- Separate abdomen and pelvis CT codes billed instead of the combined code
- Diagnosis codes that do not meet the payer’s coverage policy for the study
- Screening mammography billed as diagnostic, or the reverse
- Duplicate claim denials when the same study is read twice or billed by two groups
What we handle
Everything between the order and the payment
Our core focus is behavioral health. We bill radiology groups and imaging centers with the same team, the same process and the same promises.
- Insurance eligibility, benefits and prior authorization checks before studies
- Charge entry and coding review of CPT codes, contrast, views and component modifiers
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation, including multiple procedure reductions
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Commercial, Medicare and Medicaid credentialing for every radiologist
- Patient statements and balance tracking (patient calls go to your office or an optional RevenueCTRL virtual assistant)
- Monthly reporting on collections, denials and A/R
Pricing
Clear pricing for radiology practices
Billing starts at 2.5% of collections, or a flat monthly fee. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free when you sign up for billing. No setup fee and no long-term contract.
Common questions
Do you bill only the professional component for hospital reads?
Yes. When a radiologist reads studies performed on hospital equipment, we bill the interpretation with modifier 26 and the hospital bills the technical side. We confirm the arrangement for each site so claims do not overlap.
Can you bill global claims for our in-office imaging?
Yes. When your practice owns the equipment and your radiologist reads the study, we bill the global code with no modifier. If an outside radiologist reads it, we bill only the technical component.
Do you handle prior authorizations for MRI and CT?
We check that an authorization is on file and that it matches the CPT code before the claim goes out. If the performed study differs from the one authorized, such as adding contrast, we flag it so the authorization can be updated where the payer allows.
What do you need from the ordering physician?
We need the ordering provider’s name and NPI and a diagnosis that supports the study. For Medicare claims, the ordering provider must also be enrolled, so we check that as part of charge review.
How fast do you reply to questions?
A real person replies to calls and emails within 1 hour during business hours, Monday to Friday, 9am to 6pm Eastern.
Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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