Radiology billing, handled with care
Where radiology billing gets difficult
The issues we see most often, and the ones that quietly cost practices the most.
Orders that don’t match the study
When the study performed differs from the one ordered or authorized, the claim may be denied even though the care was appropriate.
Advanced imaging authorizations
CT, MRI and PET often require approval through a radiology benefit manager, and approvals can be tied to specific codes.
Diagnosis details from referrers
Reads depend on the reason for the exam, and vague clinical history from the referring provider can weaken medical necessity.
Multiple sites and facilities
Reading groups that cover several hospitals and centers deal with different contracts, schedules and data feeds.
How we handle them
Order and authorization matching
We compare the performed study against the order and approval, and flag mismatches before the claim is submitted.
Report-based coding
Coders work from the final signed report, including contrast use, views and laterality, rather than the scheduled exam name.
Component accuracy
We confirm the billing arrangement at each site so the professional, technical or global service is billed correctly.
Volume reconciliation
Read counts from your PACS or worklists are reconciled with billed studies so missing charges surface quickly.
Coding notes
General guidance only. Code sets update every year and payer policies vary, so we check current rules on every claim.
- Modifiers 26 and TC
- Radiologists reading at a hospital typically bill the professional component with modifier 26. Imaging centers that own equipment may bill the technical component with TC, or the global service when they also provide the read.
- Contrast and views
- Many imaging codes differ based on whether contrast was used and how many views were obtained, so the report needs to state these clearly.
- Prior authorization
- Most commercial and Medicare Advantage plans require prior authorization for advanced imaging, often through a separate benefit manager. Requirements differ by plan and study type.
- CMS imaging requirements
- Medicare rules for advanced imaging orders have changed over time, including the status of the appropriate use criteria program. Check current CMS imaging requirements before relying on older guidance.
Radiology billing questions
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