Radiology billing fails most often on questions that have nothing to do with the image: who owned the equipment, who signed the report, whether authorization was obtained, and whether the diagnosis on the order supports the study. The imaging codes themselves cover an enormous range, from plain X-ray to advanced MRI and PET, and the same study can be billed three different ways depending on how the professional and technical work is divided.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for radiology practices, built around the professional and technical split, prior authorization for advanced imaging, and the documentation that supports medical necessity.
Radiology billing challenges
The professional and technical split is the first decision on nearly every radiology claim. Modifier 26 marks the professional component, the radiologist’s supervision, interpretation, and written report. Modifier TC marks the technical component, the equipment and the technologist’s work. When one entity owns the equipment and reads the images, the code is billed globally with no modifier. When the parties are separate, each bills its own component. Billing globally when the components should have been split, or splitting a code that has no professional and technical division, both produce denials or payments to the wrong party. A signed written report is also required for the professional component: no signed report means no professional payment, regardless of whether the images were reviewed.
Code selection itself demands precision. Common examples include 71045 for a chest X-ray, 70450 for a CT of the head, and 70551 for an MRI of the brain, and contrast handling changes the code: a CT of the abdomen and pelvis with contrast only is coded differently from one performed both without and with contrast, and the report must support whichever version is billed. Laterality matters too, with RT and LT modifiers for side specific studies, modifier 50 for truly bilateral procedures, and modifier 59 reserved for genuinely distinct services, which makes it a frequent audit target. Incomplete studies are another trap: a study coded as complete must document every required element, or it must be coded as limited instead.
Prior authorization and medical necessity complete the picture. Most payers require prior authorization for CT, MRI, and PET before the study is performed, and the ordering diagnosis must appear on the payer’s covered list for that study under the applicable local coverage determination. A missing authorization, a diagnosis the coverage policy does not list, or a contrast mismatch between the report and the code are among the most common reasons radiology claims deny. Teleradiology arrangements add a further rule: when a practice bills for a component purchased from another supplier, payment limits apply, and the performing supplier must be identified on the claim.
What MedPlus RCM handles for radiology practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with commercial payers and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve radiology practices nationwide, including diagnostic imaging centers, teleradiology groups, and hospital based departments, across X-ray, CT, MRI, ultrasound, mammography, and PET imaging.
Results radiology practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
When do we use modifier 26 versus TC?
Modifier 26 is for the physician’s interpretation and report, and TC is for the equipment and technologist work. When one entity does both, bill globally with no modifier. When the parties are separate, each bills its own component.
Why do advanced imaging claims deny for authorization?
CT, MRI, and PET usually require prior authorization before the study. If authorization is missing, expired, or tied to a different study or diagnosis, the claim denies even when the imaging was clinically appropriate.
What happens if the report and the code disagree on contrast?
The claim is at risk either way. Billing a with contrast code when the report shows no contrast, or a without and with contrast code when no pre-contrast images exist, creates an overpayment risk and a denial risk.
Can a study be billed as complete if one element is missing?
No. A study coded as complete must document every required element for that study type. If an element is missing, the study should be coded as limited.
Do you handle teleradiology billing?
Yes, including the professional and technical split between the imaging site and the reading group and the claim identification rules that apply when a component is purchased from another supplier.
Get a free financial audit
Find out where your radiology practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
