Radiology billing services
Professional and technical splits, imaging authorizations and high reading volume make radiology billing a numbers game. We help make sure reads are billed and followed through to payment.
Why radiology billing takes specialty knowledge
Radiology billing runs at high volume with little contact with patients. Most demographics and orders come from referring offices, imaging authorizations are handled by radiology benefit managers, and each study may be billed globally, as a professional read only or as a technical component only. A missing authorization number or wrong component modifier turns a routine read into a denial.
SFA Solutions codes from the final signed report, matches each claim to its order and authorization and applies modifiers 26 and TC based on who owns the equipment and who reads the study. We handle imaging centers, hospital-based reading groups and teleradiology practices. We work inside your RIS or PM system, aim to submit most clean claims within 24 hours of the final report and check each claim against payer edits before it goes out.
Common codes we work with in radiology
| Code | Description |
|---|---|
| 71046 | Radiologic exam, chest, 2 views |
| 74177 | CT abdomen and pelvis with contrast |
| 70553 | MRI brain without contrast, followed by contrast and further sequences |
| 72148 | MRI lumbar spine without contrast |
| 77067 | Screening mammography, bilateral, including CAD when performed |
| 77063 | Screening digital breast tomosynthesis, bilateral (add-on) |
| 76700 | Ultrasound, abdominal, complete |
| 71271 | CT thorax, low dose for lung cancer screening, without contrast |
CPT is a registered trademark of the American Medical Association. Payer rules vary; we check each payer's current policy.
Where radiology practices lose revenue
Professional and technical components
A radiologist reading for a hospital bills only the professional component with modifier 26. An imaging center that owns the equipment and employs the radiologist bills globally with no modifier. Billing globally when the hospital owns the equipment results in denials and repayment requests.
Prior authorization through benefit managers
Most commercial and Medicare Advantage plans require authorization for CT, MRI, PET and nuclear cardiology, often through radiology benefit managers like eviCore or Carelon. The authorization must match the CPT code performed. If a study is changed from without contrast to with and without contrast, the authorization usually has to be updated.
Contrast and code selection
CT and MRI codes are chosen by contrast use: without, with, or without followed by with. Contrast material is billed separately in non-facility settings, such as Q9967 for low osmolar contrast per mL. The report must state the contrast use that the code describes.
Multiple procedure payment reductions
Medicare reduces payment for the second and later advanced imaging studies done on the same patient in the same session, on both the technical and professional components. Combined codes like 74177 (CT abdomen and pelvis with contrast) must be used instead of separate abdomen and pelvis codes when both are scanned.
What else affects radiology revenue
A/R challenges in radiology
Radiology A/R is high volume and low dollar per claim, so a small denial rate for missing authorizations or demographics turns into a large balance quickly. Reading groups often bill from data sent by hospitals and imaging centers, which can arrive late or incomplete. Underpayments from the multiple procedure payment reduction on imaging are easy to miss without line-level review.
Credentialing considerations
Radiologists need enrollment with each payer that covers the hospitals and imaging centers they read for, and teleradiologists generally need a license in each state where patients are imaged. Freestanding imaging centers enroll with Medicare as independent diagnostic testing facilities, with supervision levels set for each test. Suppliers billing Medicare for the technical component of CT, MRI, PET and nuclear medicine need accreditation from a CMS-approved organization such as the ACR.
Payer considerations
Most commercial and Medicare Advantage plans require prior authorization for advanced imaging through radiology benefit managers such as EviCore, Carelon or Evolent. Authorizations are tied to specific CPT codes, so a study that changes from without contrast to with contrast may need an updated approval. CMS rescinded the Medicare appropriate use criteria program for advanced imaging, so current payer rules are what matter.
Radiology coding details that affect payment
ICD-10 considerations
Radiology claims are coded from the final report. When the study confirms a diagnosis, that diagnosis is coded, and when the study is normal, the signs or symptoms from the order become the diagnosis. Outpatient rules do not allow coding a condition described as rule out or possible, so the reason for the study has to come through as a symptom. Screening mammography uses Z12.31, and a diagnostic mammogram after an abnormal finding uses codes in R92. Extremity studies need laterality, such as M25.561 for pain in the right knee, and lung cancer screening needs a tobacco use code such as F17.210 or Z87.891.
Modifiers to watch
| GG | Added to a diagnostic mammogram performed on the same day as a screening mammogram after the radiologist finds something that needs further views. |
|---|---|
| 76 | Used when the same study is repeated on the same day by the same physician, such as a follow-up chest X-ray after line placement. |
| 77 | Applied when a different physician repeats the same study on the same day. |
| RT and LT | Placed on extremity and breast imaging to show which side was imaged, especially when both sides are imaged separately on one date. |
| 52 | Used when fewer views or components were completed than the code describes and no lesser code exists. |
Global periods
Diagnostic imaging codes have no global period. Interventional procedures do: image-guided biopsies and paracentesis (49083) carry 0-day globals, and vertebral augmentation such as kyphoplasty (22513) carries a 10-day global.
Medicare considerations
Medicare reduces the technical component for CT scans done on equipment that does not meet the NEMA XR-29 dose standard, reported with modifier CT, and for X-rays taken with computed radiography, reported with modifier FY. Screening mammography is covered every 12 months for women 40 and older with no cost sharing. Imaging centers enrolled as independent diagnostic testing facilities must meet the physician supervision level CMS sets for each test.
Radiology billing KPIs to track
- Authorization mismatch rate. Studies that change after authorization are the main source of preventable advanced imaging denials.
- Payment compared with expected MPPR amounts. Line-level comparison catches underpayments when payers apply multiple procedure reductions incorrectly.
- Missing demographics rate. Reading groups rely on facility data, so incomplete registrations directly drive denials and timely filing losses.
- Report signed to claim submitted lag. High volume means small delays add up, and claims cannot be coded until the report is final.
Radiology billing audit checklist
- Confirm 26, TC or global billing matches who owns the equipment for each site.
- Check that authorizations match the final CPT code, including contrast use.
- Verify combined codes such as 74177 are used when abdomen and pelvis are scanned together.
- Review same-day screening and diagnostic mammograms for modifier GG.
- Confirm contrast material is billed only in non-facility settings and matches the report.
- Check that diagnoses come from the final report or the order's symptoms when the study is normal.
Related: Radiology coding · denial management · RCM · billing audit · Radiology billing in Texas · Epic billing · athenahealth billing · RCM resources
How SFA runs radiology billing
We review your reading arrangements, payer contracts and denial history to set component and authorization rules.
We match each report to its order and authorization and fill in missing demographics from referring offices.
Coders code from the signed final report with the correct component modifiers with a 24-hour target for submitting clean claims after final review.
We follow up on unpaid reads and report volume, payment and denial trends to your group.
The services that matter most for radiology
Eligibility Verification & Prior Authorization
Imaging authorizations through benefit managers must match the exact study before the patient is scanned.
Learn moreMedical Coding
Component modifiers, contrast coding and combined codes decide payment on each read.
Learn moreA/R Recovery
High-volume, low-dollar radiology claims build up in A/R quickly when no one follows them up.
Learn moreWhat practices typically see with SFA
Averages and selected client results. Your free audit shows where your own numbers stand today.
Target for the claims we manage, not a measured average.
Highest improvement seen in selected client results.
Largest drop in A/R days seen in selected client results.
Targeted for submission within 24 hours after final review.
From primary care and nurse practitioners to surgery and imaging.
We work inside the system your practice already uses.
Results vary by practice, specialty, payer mix, claim volume, billing history, documentation and other factors. Performance figures represent average or selected client results and are not guarantees of future performance. The 95% figure is a clean-claim target, not a measured cohort. The client-results page does not include a measurement period, starting collections, or practice size.
Radiology billing questions
When do we use modifier 26?
Use modifier 26 when your radiologist interprets a study but your group does not own the equipment or employ the technologist, such as reads for a hospital. The hospital bills the technical component.
What happens if the study performed does not match the authorization?
Many payers deny the claim. Most benefit managers allow the authorization to be updated within a short window after the study, so it is important to catch changes the same day.
Is screening tomosynthesis billed separately?
Screening 3D mammography is billed with add-on 77063 along with 77067. Diagnostic tomosynthesis for Medicare uses G0279 with the diagnostic mammography code.
Do you bill for teleradiology groups?
Yes. We bill teleradiology reads with the correct place of service and components, and we handle credentialing in the states and facilities where your radiologists read.
How do you handle missing patient insurance information?
We contact the ordering office or facility for the missing details and verify eligibility before filing, so claims are not lost to timely filing limits.
See what your radiology billing is missing
Send us a few details and an RCM specialist who knows radiology will review where claims are denied, underpaid or left unbilled.
- A clear walkthrough of what we find
- Reply typically within one business day
- No commitment
Request your free practice audit
An RCM specialist typically replies within one business day.