Radiology Billing Services
Radiology billing turns on one question asked per study - which component did you actually earn - and the answer depends on the setting, not on a single house rule. Three arrangements cover most of it. A group that owns its equipment and employs the reading radiologist, and bills for both, reports the study globally with no component modifier. A group that only interprets studies performed somewhere else reports the professional component with modifier 26. A free-standing imaging center or independent diagnostic testing facility that owns the scanner but contracts the reads out reports the technical component with modifier TC. The hospital case is the one most often stated wrongly: when a study is furnished to a hospital patient, the Medicare contractor will not pay a supplier for the technical component - the hospital is paid for it - but the radiologist's interpretation is still paid under the physician fee schedule, in all settings, as long as it is an identifiable, direct and discrete service to an individual patient with a written report. That is the Medicare Claims Processing Manual, Chapter 13, sections 20.1 and 20.2.1, read 17 September 2026; the hospital does not capture a 'global' and the radiologist does not bill nothing. On top of the component question sit three payment mechanics: the multiple procedure payment reduction on same-session diagnostic imaging, the contrast split where MRI brain without contrast (70551), with contrast (70552) and without-then-with (70553) are three distinct codes with three fee schedule amounts, and the radiology benefit manager prior-authorization gate at the commercial plans. This page covers how radiology billing actually plays out across MRI, CT, mammography, ultrasound and IR, and what stops the most common revenue leaks at each one.
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What do radiology billing services handle?
We run billing for radiology groups, imaging centers and teleradiology practices: study coding, prior authorization through the radiology benefit manager, submission, denial work and A/R. What decides payment on a radiology claim is component ownership by setting - global only where your group bills for both the equipment and the read, modifier 26 where you interpret studies performed elsewhere, modifier TC where you own the scanner and contract the reading out. One correction worth stating plainly, because a lot of published guidance is still out of date: the Appropriate Use Criteria program is not a live claim requirement. CMS paused implementation and rescinded the AUC regulations at 42 CFR 414.94 effective 1 January 2024, and told providers to stop submitting AUC consultation information on Medicare fee-for-service claims - see CMS, Appropriate Use Criteria Program, verified 17 September 2026. The dollar figures in the code table below are CY2026 Medicare national unadjusted global amounts (both components) - total RVUs times the 33.4009 nonqualifying-APM conversion factor in the CY2026 PFS relative value file. If you bill 26 only, expect roughly a third of the listed figure on the cross-sectional studies; if TC only, roughly two thirds.
- Global, modifier 26 and modifier TC set per study by the setting and by who bills for the equipment and the interpretation
- Contrast coded to the study actually performed - 70551 without, 70552 with, 70553 without-then-with - checked against the report and the technologist log before submission
- MPPR planned for on same-session imaging, so the reduced technical component on the second study is expected rather than chased as an underpayment
- Advanced imaging cleared before the scan through the plan's radiology benefit manager - eviCore, or Carelon Medical Benefits Management, which took over the clinical review that used to sit under AIM Specialty Health - which is the live authorization gate now that the AUC program is paused
- Contracted reads checked against Medicare's anti-markup payment limitation rather than billed as though the group performed them
Who This Page Is For
Common Billing Friction in Radiology
TC/26 split - the per-study modifier discipline, and what the hospital case actually is
Every diagnostic imaging study carries a technical and a professional component, and the CY2026 fee schedule splits them explicitly. MRI brain without-then-with contrast (70553) is about $317 global on the Medicare national non-facility amounts, of which roughly $105 is the professional component and $212 the technical - so a radiologist reading a study performed at an outside hospital bills 26 and earns the $105 portion, while an imaging center that owns the scanner and contracts the read out bills TC and earns the $212 portion. The case most often described wrongly is the hospital one. For a study furnished to a hospital patient, the Medicare contractor will not pay a supplier the technical component - it is paid to the hospital - but the interpretation is still paid under the physician fee schedule in all settings when it is an identifiable, direct and discrete service with a written report (Medicare Claims Processing Manual Chapter 13, sections 20.1 and 20.2.1, read 17 September 2026). Billing global where only one component was earned is the most common audit finding in this specialty; billing a component where global was earned leaves the other component unbilled.
MPPR - the multiple procedure payment reduction on same-session diagnostic imaging
When two or more diagnostic imaging procedures carrying the imaging MPPR flag are furnished in the same session on the same day, the technical components are ranked by fee schedule amount: the highest pays at 100 percent and every subsequent one at 50 percent. The professional components of the second and subsequent procedures are reduced by 5 percent, a level that has applied since 1 January 2017 (it was 25 percent from 2012 through 2016). The 'families' framing you will still see quoted is stale - CMS stopped populating the eleven family indicators for services furnished on or after 1 January 2011 and now flags the affected codes with a single indicator, so the reduction reaches across modalities rather than only within one family. Worked example on the CY2026 national amounts: CT abdomen and pelvis with contrast (74177) carries a technical component of about $216 and CT chest without contrast (71250) about $83; run in the same session, 74177's technical component pays in full and 71250's is halved to roughly $42. Mammography is a useful exception - 77065, 77066 and 77067 are not flagged for the imaging MPPR at all. Source: CMS, CY2026 PFS relative value file documentation, read 17 September 2026.
Contrast coding split - without (70551), with (70552), without-then-with (70553)
MRI and CT exam codes split into distinct CPT codes by contrast usage, each with its own fee schedule amount. On the CY2026 Medicare national global amounts, MRI brain runs about $195 for 70551 without contrast, $269 for 70552 with contrast and $317 for 70553 without-then-with; MRI lumbar spine runs about $192 for 72148, $270 for 72149 and $318 for 72158. Coding a without-then-with study as without-only gives up the difference; coding a without-only study as 70553 invites a recoupment when the contrast administration is absent from the report and the technologist log. One rule that catches groups out on the high-dose contrast technique: where 70553 is billed, Medicare makes no separate payment for 70551 furnished in the same session, because the code definition already includes the further sequences (Medicare Claims Processing Manual Chapter 13, section 40, read 17 September 2026).
AUC and clinical decision support - the requirement that was paused, and what replaced it operationally
The Appropriate Use Criteria program would have required an ordering provider to consult a qualified clinical decision support mechanism before ordering advanced imaging, with the consultation identifier and an outcome modifier on the rendering provider's claim. It never reached that stage. In the CY2024 Physician Fee Schedule final rule CMS paused implementation for reevaluation and rescinded the AUC regulations at 42 CFR 414.94, effective 1 January 2024; providers were told to stop submitting AUC consultation information on Medicare fee-for-service claims, and CMS stopped qualifying provider-led entities and CDS mechanisms. Claims containing AUC-related codes with 2023 and 2024 dates of service continued to process through 31 December 2024. So there is no AUC consultation identifier to chase on a 2026 claim, and any workflow still inserting one is carrying dead weight. What is live is commercial prior authorization through the radiology benefit managers, which applies their own appropriateness criteria and is the real gate on advanced imaging today. Source: CMS, Appropriate Use Criteria Program, verified 17 September 2026.
Mammography 77065/77066/77067 - the screening versus diagnostic split and the tomosynthesis add-ons
Mammography splits cleanly, and on the CY2026 Medicare national global amounts: 77067 screening bilateral about $126, 77065 diagnostic unilateral about $124, 77066 diagnostic bilateral about $157. Tomosynthesis is an add-on and the add-on code depends on which base study it accompanies - +77063 is the screening add-on (about $51 global), and G0279, whose Medicare descriptor reads 'diagnostic digital breast tomosynthesis, unilateral or bilateral', is listed separately in addition to 77065 or 77066 (about $40 global). A screening study that finds an abnormality and converts to a same-day diagnostic mammogram needs careful coding, because the same study cannot be billed as both; billing 77067 and 77066 for the same patient on the same date is a standard route to a medically unlikely edit denial. Descriptor and amounts from the CY2026 HCPCS and PFS files, read 17 September 2026.
Radiology-Specific Payer Issues We Watch For
Medicare
Issue: Same-session diagnostic imaging is subject to the multiple procedure payment reduction: technical components are ranked by fee schedule amount, the highest pays in full and each subsequent one at 50 percent, and the professional components of subsequent procedures are reduced 5 percent. Practices that model revenue without it read the reduced payment as an underpayment and open an appeal that will not succeed
Our approach: We apply the reduction to the expected-payment model before the claim goes out, so multi-study sessions are reconciled against the right number and the A/R queue only carries genuine variances
UnitedHealthcare
Issue: UnitedHealthcare routes advanced imaging authorization through a radiology benefit manager whose criteria are often narrower than general clinical guidelines, and the criteria applied depend on the specific plan and product rather than being uniform across the carrier
Our approach: We submit prior authorization through UHC's designated RBM with clinical documentation configured to the specific authorization criteria used by that RBM
BCBS
Issue: Blue Cross Blue Shield plans are independent licensees, and several apply their own contrast-necessity criteria that can deny a contrast-enhanced study the radiologist considered indicated. The criteria and the appeal path differ by licensee, so there is no single BCBS rule to code against
Our approach: We document the clinical rationale for contrast administration in the order and the report, check the specific licensee's medical policy before the study where time allows, and support the ICD-10 coding that policy expects
Aetna
Issue: Several commercial plans treat 3D rendering (76376, 76377) as inclusive of the base imaging study and deny it, and the plans that do pay it generally require the rendering to be requested and to add something the base study did not show
Our approach: We bill 3D rendering separately only where the report documents that it was requested and what it added, and we check the plan's policy rather than assuming the Medicare treatment applies
What We Handle
TC/26 modifier discipline set by your actual setting
Per-study modifier application based on who bills for the equipment and who bills for the interpretation - global where both are earned, modifier 26 for outside-facility reads, modifier TC for imaging centers and IDTFs without in-house interpretation, and the professional component only where the study was furnished to a hospital patient. Includes checking contracted reads against Medicare's anti-markup payment limitation, which caps the allowed amount and requires the performing physician and their net charge to be identified on the claim when that physician does not share a practice with the billing entity.
MRI billing — 70551/70552/70553 brain, 72148/72149/72158 lumbar, 73721/73722/73723 lower-extremity joint
Contrast-aware MRI coding with the without / with / without-then-with split applied per anatomy, keeping the families distinct: brain is 70551-70553, lumbar spine 72148/72149/72158, lower-extremity joint 73721-73723, upper-extremity joint 73221-73223 and abdomen 74181-74183. Includes modifier 26 where the group only reads, and MPPR projection for same-session multi-MRI cases.
CT billing — 74177, 71250/71260/71270, contrast hierarchies
CT abdomen-pelvis with contrast (74177), CT chest variants 71250/71260/71270, head 70450/70460/70470, with the contrast-coding split applied per study and MPPR awareness when CT and another imaging modality run in the same session.
Mammography — 77065, 77066, 77067 with tomosynthesis add-on
Screening 77067 with the +77063 tomosynthesis add-on, diagnostic 77065/77066 with the G0279 add-on, which Medicare defines as listed separately in addition to 77065 or 77066, and the screening-to-diagnostic conversion logic when an abnormality is detected. Mammography is not subject to the imaging MPPR. Screening frequency is set by Medicare nationally and by each Blue Cross Blue Shield licensee or commercial plan separately, so we check the specific plan rather than applying one eligibility rule across all of them.
Ultrasound and IR procedure billing
Diagnostic ultrasound (76700 abdomen complete, 76705 abdomen limited, 76830 transvaginal) with TC/26 components, and interventional radiology procedure coding for vascular access, embolization, biopsies, and drainage with the radiologic supervision and interpretation (RS&I) codes paired to the procedure codes.
RBM prior authorization and order-to-report-to-claim reconciliation
Prior authorization submission through the radiology benefit managers with the clinical packet aligned to that RBM's own appropriateness criteria, plus a reconciliation between the modality worklist, the signed report and the claim: every scheduled order matched to a completed study, every completed study matched to a final signed report, and every signed report matched to a submitted claim line with the contrast status and component modifier that the report and technologist log actually support. Studies performed but never reported, and studies reported but never billed, are found by that reconciliation and by nothing else.
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Key Radiology CPT Codes
| CPT Code | Description | Medicare Amount CY2026 national, non-facility |
|---|---|---|
| 70553 | MRI brain, without contrast followed by with contrast | $317 |
| 74177 | CT abdomen and pelvis with contrast | $300 |
| 71046 | Chest X-ray, 2 views | $33 |
| 73721 | MRI joint of lower extremity without contrast | $204 |
| 77067 | Screening mammography, bilateral, including CAD | $126 |
| 76536 | Ultrasound, head and neck soft tissue | $109 |
| 72148 | MRI lumbar spine without contrast | $192 |
| 77012 | CT guidance for needle placement (biopsy) | $123 |
Amounts are the Medicare national unadjusted non-facility amounts for CY2026, computed from the published CMS relative value file. They are not what a commercial payer pays, and your locality adjustment moves them. A dash means Medicare publishes no amount for that code — because it is non-covered, bundled, or priced outside the fee schedule.
Why General Billing Teams Miss Radiology Issues
General billing staff handle dozens of specialties and rarely develop the depth needed for radiology coding nuances. Here is what gets missed.
Modifier and bundling errors
Specialty-specific modifier rules and CCI edits are frequently overlooked by teams that do not work exclusively in radiology.
Under-coding high-complexity visits
Radiology encounters often qualify for higher-level E/M codes, but generalist billers default to mid-level codes to avoid audit risk.
Missed payer-specific rules
Each payer has unique coverage and documentation requirements for radiology procedures that general teams rarely memorize.
Slow denial turnaround
Without specialty knowledge, appeal letters lack the clinical specificity needed to overturn radiology denials quickly.
“Most of the money a radiology group loses is lost twice over on the same two questions: which component did we actually earn in this setting, and did the contrast phase on the claim match the phase in the report. Fix those and the denial queue gets noticeably quieter.”
MedPrecision Billing Team
Radiology Billing and Coding Director
Transition Plan
Switching billing partners should not disrupt patient care or cash flow. Our transition plan is designed for zero downtime.
Discovery and Specialty Audit
We review your current radiology billing workflows, denial patterns, and payer mix to build a tailored onboarding plan.
System Integration
We connect to your EHR and practice management system, configure specialty-specific code sets, and validate charge capture workflows.
Parallel Billing Period
We run billing in parallel with your current process for 2-4 weeks to verify accuracy before taking over completely.
Full Transition and Reporting
Once validated, we assume full billing responsibility with monthly reporting dashboards and a dedicated account manager.
Radiology Billing Terms
- Professional Component (26)
- The radiologist's interpretation and written report for an imaging study, billed with modifier 26 where the billing entity did not also bill the equipment side. Medicare pays the professional component under the physician fee schedule in all settings, including for hospital patients, where the service is identifiable, direct and discrete to an individual patient.
- Technical Component (TC)
- The equipment, facility and technologist cost of performing a study, billed with modifier TC. For studies furnished to hospital patients the Medicare contractor does not pay a supplier the technical component; it is paid to the hospital. Technical plus professional equals the global service.
- Appropriate Use Criteria / Clinical Decision Support (paused)
- A Medicare program that would have required ordering providers of advanced imaging to consult a qualified clinical decision support mechanism and put the resulting consultation identifier on the rendering claim. CMS paused implementation and rescinded the regulations at 42 CFR 414.94 effective 1 January 2024 and told providers to stop submitting the consultation information. It is not a live claim requirement.
- Radiology Benefit Manager (RBM)
- A third-party company contracted by a commercial payer to manage prior authorization for advanced imaging. Each RBM applies its own clinical criteria, which may be narrower than general medical guidelines, and the criteria in force depend on the specific plan and product. With the Medicare AUC program paused, RBM authorization is the operative appropriateness gate on advanced imaging.
- Contrast Enhancement Coding
- Imaging studies are coded differently based on whether contrast is used: without contrast, with contrast, or with and without contrast. Each version has a distinct CPT code with different reimbursement rates.
- 3D Rendering (76376/76377)
- Post-processing of imaging data into three-dimensional images with concurrent physician supervision and interpretation. 76377 is the version requiring an independent workstation; 76376 is the version that does not. Both are add-on services and several commercial plans treat them as inclusive of the base study.
Last updated: 2026-09-17
Common Questions
Common questions about radiology billing services.
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Request ReviewHow do you decide between global, professional and technical component billing?
By setting, per study. If your group bills for both the equipment and the radiologist's read, we bill globally. If you provide interpretation only, we bill the professional component with modifier 26. If you own the equipment and contract the reading out, we bill the technical component with modifier TC. Where a study is furnished to a hospital patient, the Medicare contractor will not pay a supplier the technical component - that is paid to the hospital - but the radiologist's interpretation is still payable under the physician fee schedule, so the read is billed with modifier 26 rather than written off. Where the component you bill was performed by a physician who does not share a practice with you, Medicare's anti-markup payment limitation caps the allowed amount and requires the performing physician's identity and net charge on the claim. The rules are in the Medicare Claims Processing Manual, Chapter 13, sections 20.1, 20.2.1 and 20.3, read 17 September 2026.
What is the process for getting advanced imaging authorised?
We submit the authorization request through the plan's radiology benefit manager portal with the clinical packet that RBM's criteria call for - presenting symptoms, prior imaging and its findings, conservative treatment already tried, and the clinical indication - then track the pending request and appeal denials with additional documentation or a peer-to-peer where the plan allows one. Note that this is now the only appropriateness gate that matters on the claim: the Medicare Appropriate Use Criteria program was paused and its regulations rescinded effective 1 January 2024, and CMS instructed providers to stop putting AUC consultation information on fee-for-service claims - see CMS, Appropriate Use Criteria Program, verified 17 September 2026.
How do you code CT or MRI studies performed with and without contrast?
We use the single combination code for the study actually performed rather than billing the without and with phases separately - but the combination code has to match the anatomy as well as the contrast sequence. CT of the abdomen alone without contrast followed by with contrast is 74170, not 74178: 74150, 74160 and 74170 are the abdomen-only family, while 74176, 74177 and 74178 are the abdomen-and-pelvis family. Picking the wrong family is a different error from picking the wrong contrast phase and it produces a different denial. Anatomy-and-contrast pairings confirmed against the CY2026 PFS relative value file, read 17 September 2026.
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