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Radiology Billing Services

Every imaging study has two halves: the technical work of producing the images and the professional work of reading them. Who owns the equipment and who signs the report decide whether a study is billed globally, as a professional component or as a technical component, and the claim also has to carry an authorized order from an eligible ordering provider.

  • Global, -26 and TC billing set by site and equipment ownership
  • Benefit manager authorizations matched to the CPT code performed
  • Ordering provider NPI and eligibility checked before submission
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Who bills which half of an imaging study

A radiology group reading for a hospital bills only the professional component with modifier 26, while the hospital bills the technical component on its facility claim. An imaging center or practice that owns its scanners and employs the radiologist bills globally. Groups that do both, plus teleradiology for outside sites, need the right split for every location they read for.

Advanced imaging is one of the most heavily managed services in medicine. Many commercial and Medicare Advantage plans route CT, MRI, PET and nuclear studies through a radiology benefit manager, and an approval for a CT without contrast does not cover a CT with and without contrast. When the radiologist changes the protocol, the authorization has to change with it.

The ordering provider is part of the claim too. Medicare expects diagnostic tests to be ordered by the treating practitioner, and the ordering provider's name and NPI must be on the claim, with that practitioner enrolled in Medicare or validly opted out. A missing or ineligible ordering provider denies a correctly performed and read study.

Imaging components, contrast and repeat-study modifiers

Reference points for the coding decisions that radiology claims depend on.

Radiology modifiers and code rules with billing notes
Code or modifierMeaningBilling notes
26Professional component: supervision, interpretation and the signed report.Used when the facility owns the equipment and bills the technical side.
TCTechnical component: equipment, staff, supplies and image production.Billed by the owner of the equipment when someone else provides the official read.
Contrast code variantsCT and MRI families have separate codes for without contrast, with contrast, and without followed by with contrast.Bill the code that matches what was actually performed, not what was ordered, and update the authorization if it changed.
Contrast agentsHCPCS supply codes for contrast material, such as low-osmolar and gadolinium-based agents.Billed separately by the office or imaging center that supplies the agent; in hospital outpatient care its cost is packaged into the facility payment.
76, 77Repeat procedure by the same physician, and by another physician.Used for repeat studies on the same day, with documentation of why the repeat was needed.
Multiple procedure reductionsSeveral advanced imaging studies for the same patient in the same session.Medicare reduces payment for both the technical and professional components of the later studies, which affects how expected payments are checked.
77065 to 77067Diagnostic mammography, unilateral and bilateral, and screening mammography.Screening and diagnostic studies are covered differently, so the reason for the study must be clear.

CPT is a registered trademark of the American Medical Association.

Official sources: CMS Claims Processing Manual, chapter 13 (radiology) (external site), CMS Claims Processing Manual, chapter 4 (modifiers 76 and 77) (external site), eCFR: 42 CFR 424.507 (ordering and referring) (external site), eCFR: 42 CFR 410.32 (orders for diagnostic tests) (external site), eCFR: 42 CFR 419.2 (hospital outpatient packaging) (external site), CMS: RVU file (imaging descriptors and reduction indicators) (external site)

Imaging claim problems we fix most

  • Global billed for a hospital study

    The facility already billed the technical component, so a global claim from the reading group is denied or later recouped.

  • Authorization covers a different code

    Approved without contrast, performed with and without, or an approval for one body area used for another.

  • Ordering provider missing or ineligible

    No ordering NPI on the claim, or the ordering practitioner is not enrolled to order for that payer.

  • Diagnosis does not support the study

    Symptoms coded too vaguely for the payer's coverage policy, or the reason for the study was not carried over from the order.

  • Duplicate reads

    Two radiologists billing the professional component for the same study, such as a preliminary and a final read.

From order to read: our radiology workflow

  1. Step 1: Map each reading site

    For every hospital, imaging center and teleradiology client, we record who owns the equipment and which component you bill.

  2. Step 2: Match the study to the authorization

    The performed CPT code, including contrast, is compared with the approval before the claim goes out.

  3. Step 3: Validate the order

    Ordering provider, NPI, diagnosis and order date are checked so the claim carries a complete, eligible order.

  4. Step 4: Reconcile reads to studies

    Interpretations are matched one-to-one with performed studies so none are missed or billed twice.

What an imaging order needs before the claim

Missing order details are one of the most avoidable causes of imaging denials.

  • Ordering provider name and NPI

    The treating practitioner who ordered the study, eligible to order for the patient's payer.

  • A specific reason for the study

    Diagnosis codes or signs and symptoms precise enough to meet the payer's coverage policy.

  • The exact study requested

    Body area, contrast and protocol, so any change at the scanner can be authorized.

  • Authorization reference

    The approval number and the codes and dates it covers, for plans that require one.

Frequently asked questions

When should a radiology group bill globally instead of with modifier 26?

When the group or its owners own the equipment and employ the staff who perform the study, and the group's radiologist reads it. If a hospital or another entity owns the equipment, the group bills only the professional component.

What happens if the protocol changes after the study is authorized?

The authorization usually needs updating to the code actually performed, often within a short window after the study. Billing a code the approval does not cover is one of the most common imaging denials.

Why was a correctly read study denied for the ordering provider?

Medicare and other payers check that the ordering practitioner is identified and eligible to order. If the NPI is missing or the practitioner is not enrolled, the claim can deny even though the study was medically necessary.

Can both a preliminary and a final read be billed?

For emergency room X-rays and EKGs, Medicare generally pays for one interpretation and pays a second only in unusual, documented circumstances. Preliminary reads are usually handled by an arrangement between the groups rather than billed separately.

Who bills for the contrast agent?

In an office or imaging center that buys the agent, it is billed with a HCPCS code alongside the study. In hospital outpatient care its cost is packaged into the hospital's payment for the study.

Related services and specialties

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