Expert Radiology Medical Billing & RCM Services
Specialized revenue cycle management for imaging centers and radiology practices. Maximize reimbursements for diagnostic imaging, interventional radiology, and teleradiology services with our expert billing solutions.
Radiology Billing Challenges We Solve
Medical imaging billing requires specialized expertise in component coding, bundling rules, and complex modifiers.
Professional vs Technical Component Separation
Radiology services involve distinct professional (interpretation and report) and technical (equipment, technologist, supplies) components that can be billed separately or together. Proper modifier usage (TC for technical, 26 for professional, or no modifier for global) is critical. Misuse causes denials and compliance issues, especially when reading radiologists are at different facilities than where imaging is performed.
Revenue Impact:
Component billing errors result in 20-35% revenue loss and frequent payer audits
Bundling Edits and Multiple Procedure Discounts
When multiple imaging studies are performed on the same day, CCI edits and payer bundling rules apply complex reduction logic. The highest-valued procedure is paid at 100%, with subsequent procedures reduced by 25-50% depending on payer. Add-on codes, bilateral procedures, and contrast usage further complicate coding. Understanding which codes bundle and proper sequencing is essential.
Revenue Impact:
Bundling errors and improper sequencing cost imaging centers $75,000-$200,000 annually
Interventional Radiology Procedure Complexity
Interventional radiology combines diagnostic imaging with therapeutic procedures, requiring precise documentation of access sites, guidance modalities, contrast usage, and procedural components. Coding must capture all billable elements including imaging supervision and interpretation codes (S&I), catheter placements, and therapeutic interventions while adhering to bundling rules.
Revenue Impact:
Interventional radiology undercoding results in $100,000-$300,000 lost revenue per physician
Contrast Media and Supply Billing
High-osmolar vs low-osmolar contrast agents have different billing codes and reimbursement rates. Oral vs intravenous contrast affects CPT code selection (e.g., CT abdomen with vs without contrast). Proper documentation of contrast type, dosage, and medical necessity is required. Power injector supplies, catheters, and other materials must be tracked and billed appropriately.
Revenue Impact:
Contrast and supply billing gaps create $30,000-$80,000 in uncollected revenue annually
Prior Authorization and Medical Necessity
Advanced imaging (MRI, CT, PET) increasingly requires prior authorization with detailed clinical information and adherence to appropriateness criteria (ACR guidelines). Denials for lack of medical necessity are common when documentation doesn't support imaging choice or frequency. Specialty-specific guidelines and payer requirements vary significantly.
Revenue Impact:
Prior authorization denials and medical necessity issues cost practices $50,000-$150,000 per year
Teleradiology and Multi-Site Billing Coordination
When radiologists provide interpretations for multiple facilities or via teleradiology, complex billing coordination is required. Proper place of service codes, facility billing vs professional billing, credentialing at each site, and state licensure compliance all impact reimbursement. Split billing arrangements and percentage-based contracts add further complexity.
Revenue Impact:
Multi-site coordination errors result in 15-25% of professional component claims being denied
Radiology Service Categories We Optimize
Comprehensive billing expertise across all imaging modalities and interventional procedures
Diagnostic Radiology (X-Ray, Fluoro)
Plain films, fluoroscopy, contrast studies including upper GI, barium enema, and specialized radiographic procedures
Common Codes
71045-71048 (Chest), 72020-72120 (Spine), 74000-74190 (Abdomen), 74210-74363 (GI Studies)
Avg. Reimbursement
$25-$300 per study
Frequency
High volume daily studies
CT Imaging
Computed tomography scans with and without contrast across all body regions including specialized protocols
Common Codes
70450-70498 (Head/Neck CT), 71250-71275 (Chest CT), 72125-72133 (Spine CT), 74150-74178 (Abdomen/Pelvis CT)
Avg. Reimbursement
$200-$1,200 per study
Frequency
Multiple daily studies in most centers
MRI Imaging
Magnetic resonance imaging with and without contrast for all body regions including specialized sequences and functional studies
Common Codes
70540-70559 (Brain MRI), 71550-71552 (Chest MRI), 72141-72158 (Spine MRI), 74181-74183 (Abdomen MRI)
Avg. Reimbursement
$400-$2,000 per study
Frequency
Daily studies, appointment-based scheduling
Interventional Radiology
Image-guided therapeutic procedures including vascular access, biopsies, drainages, embolizations, and ablations
Common Codes
36000-37799 (Vascular Procedures), 47000-47015 (Biopsies), 75600-75989 (Angiography), 61624-61626 (Embolization)
Avg. Reimbursement
$500-$5,000 per procedure
Frequency
Multiple weekly procedures in IR suites
Nuclear Medicine & PET
Nuclear medicine scans, PET imaging, and therapeutic radiopharmaceutical administration
Common Codes
78000-78999 (Nuclear Medicine), 78608-78816 (PET Imaging), 79000-79999 (Therapeutic Nuclear)
Avg. Reimbursement
$800-$3,500 per study
Frequency
Daily PET/CT studies, variable nuclear medicine volume
Our Radiology Billing Performance
Consistently outperforming industry benchmarks in imaging billing
Clean Claim Rate
Our Performance
98.5%
Industry Avg.
87.8%
Component Coding Accuracy
Our Performance
99.1%
Industry Avg.
89.4%
Average Days to Payment
Our Performance
19 days
Industry Avg.
32 days
Prior Authorization Approval Rate
Our Performance
96.8%
Industry Avg.
84.2%
Denial Rate
Our Performance
1.1%
Industry Avg.
5.6%
Net Collection Rate
Our Performance
98.7%
Industry Avg.
91.5%
Radiology Practice Success Stories
Real results from imaging centers and radiology practices using our specialized billing services
Multi-Modality Imaging Center
Diagnostic Imaging - CT, MRI, X-Ray, Ultrasound
Challenge
A free-standing imaging center with CT, MRI, X-ray, and ultrasound capabilities was experiencing 11% denial rate primarily from component coding errors (26/TC modifier issues), bundling violations when multiple studies were ordered, and contrast billing inconsistencies. Their prior authorization process was manual and slow, causing 25+ day delays in scheduling and frequent denials.
Solution
Implemented component-based coding workflows with automated 26/TC modifier assignment based on service location and physician relationship. Created bundling edit software that sequences procedures by RVU value and applies MPPR reductions correctly. Developed contrast billing protocols tied to CPT code selection. Deployed automated prior authorization system integrated with payer portals.
Results Achieved
Hospital-Based Radiology Department
Full-Service Radiology Including Interventional
Challenge
A 200+ bed hospital radiology department with diagnostic and interventional services was struggling with complex interventional radiology coding, incomplete capture of S&I codes, poor coordination between technical and professional billing, and high denial rates on vascular procedures. Their radiologists provided services at 3 hospital locations, creating credentialing and billing coordination challenges.
Solution
Deployed specialized interventional radiology coders with vascular procedure expertise. Implemented automated S&I code pairing with procedural codes and catheter placement tracking. Created unified billing platform coordinating technical hospital charges with professional radiologist billing. Established multi-site credentialing tracking and place of service code management.
Results Achieved
Teleradiology Practice Group
Professional Radiology Interpretations
Challenge
A 15-radiologist teleradiology group providing interpretations for 40+ facilities nationwide was experiencing fragmented billing, inconsistent modifier usage across sites, poor tracking of which studies were read by which radiologists, and 18% denial rate on professional component claims. Revenue reconciliation with client facilities was problematic, and they lacked visibility into productivity and reimbursement by radiologist.
Solution
Implemented centralized radiology-specific billing platform with automated study assignment tracking linking each interpretation to the reading radiologist and originating facility. Created site-specific coding rules managing modifier requirements, fee schedules, and payer contracts. Developed comprehensive reporting showing productivity, reimbursement, and denial rates by radiologist and facility. Established revenue reconciliation workflows with client facilities.
Results Achieved
Why Radiology Practices Choose Healix RCM
Specialized expertise that delivers measurable results for imaging billing
Radiology Specialists
Certified coders with specialized radiology training and deep expertise in component coding, interventional procedures, and modifiers
Revenue Optimization
Maximize reimbursement through proper component separation, bundling optimization, and complete capture of interventional procedures
Faster Payments
Average 19-day payment cycle with 98.5% clean claim rate ensures excellent cash flow for your imaging center
Compliance Expertise
Stay compliant with CCI edits, MPPR rules, modifier requirements, and Stark/Anti-Kickback regulations
Technology Integration
Seamless integration with RIS/PACS systems and automated prior authorization workflows for all major payers
Proven Results
Track record of increasing radiology practice revenue by 25-45% through comprehensive billing optimization
Frequently Asked Questions
Common questions about radiology medical billing and our services
How do professional and technical components work in radiology billing?
Radiology services have two components: technical (equipment, technologist, supplies, overhead) and professional (physician interpretation and report). When both are provided by the same entity, the global code is billed without modifiers. When separate entities provide each component, modifier TC (technical component) is used for the facility/equipment side, and modifier 26 (professional component) is used for the physician interpretation. For example, if a patient gets an MRI at a hospital and it's read by a teleradiology group, the hospital bills the technical component with modifier TC, and the radiologist bills the professional component with modifier 26. Proper coordination prevents double-billing and ensures each provider is appropriately reimbursed.
What is the Multiple Procedure Payment Reduction (MPPR) and how does it affect radiology billing?
MPPR is a Medicare and payer policy that reduces payment when multiple imaging procedures are performed on the same day in the same family of services. The highest-valued procedure (by RVU) is paid at 100%, and subsequent procedures are reduced by 25-50% for the technical component (professional component typically not reduced for diagnostic imaging, but is for therapy services). Proper sequencing of CPT codes is critical - we must list the highest RVU procedure first to maximize reimbursement. Our billing systems automatically sequence procedures correctly and calculate expected MPPR reductions for accurate payment posting and variance analysis.
How do you handle contrast media billing in CT and MRI studies?
Contrast usage affects CPT code selection rather than being separately billable in most cases. For CT and MRI, there are distinct codes for studies 'without contrast,' 'with contrast,' and 'without contrast followed by with contrast and further sequences.' The correct code must be selected based on what was actually performed and documented. For example, CT abdomen has three codes: 74150 (without contrast), 74160 (with contrast), and 74170 (without and with contrast). The radiologist's report must document contrast type (low vs high osmolar), dosage, route, and medical necessity. In some settings, high-cost contrast agents may be separately billable with HCPCS codes, but this is payer-specific. We ensure proper code selection and documentation to support contrast usage.
What are the most common radiology billing mistakes?
Common errors include: 1) Incorrect modifier 26/TC usage or missing modifiers, 2) Billing global codes when only one component was provided, 3) Improper sequencing causing incorrect MPPR application, 4) Billing bundled codes separately (e.g., separately billing components included in a comprehensive code), 5) Wrong contrast-based code selection (with vs without), 6) Missing S&I codes in interventional procedures, 7) Billing unlisted codes when specific CPT codes exist, 8) Inadequate medical necessity documentation for advanced imaging, 9) Missing bilateral modifiers when appropriate, and 10) Incorrect place of service codes in multi-site scenarios. Our specialty-trained coders and automated scrubbing prevent these errors.
How do you maximize interventional radiology reimbursement?
Interventional radiology optimization requires capturing all billable components: 1) Base procedure codes (catheter placement, vascular access), 2) Imaging supervision and interpretation (S&I) codes that accompany procedures, 3) All catheter placements and vessel selections, 4) Appropriate modifiers for bilateral procedures and multiple vessels, 5) Supply billing for devices (stents, coils, embolic agents), 6) Proper sequencing of bundled procedures, and 7) Documentation supporting medical necessity and complexity. For example, a renal artery stent placement includes vessel access, selective catheterization, angiography, stent placement, and S&I codes - missing any component significantly reduces reimbursement. Our IR-specialized coders review procedure notes and ensure complete, compliant coding.
How do you handle prior authorizations for advanced imaging?
Prior authorization for CT, MRI, and PET imaging requires: 1) Integration with payer portals (eviCore, AIM, NIA) for real-time requirements checking, 2) Clinical documentation supporting medical necessity and appropriateness per ACR criteria, 3) Submission of relevant ICD-10 codes, prior imaging results, and clinical history, 4) Tracking authorization status to prevent unverified studies, and 5) Appeal workflows when authorizations are denied. We implement technology that checks authorization requirements at scheduling, interfaces with decision support systems, and automates submission. Our team monitors approval status and coordinates with ordering physicians when additional documentation is needed. This reduces authorization-related delays from weeks to days.
What documentation is required for radiology medical necessity?
Medical necessity documentation includes: 1) Specific ICD-10 diagnosis codes justifying the imaging study, 2) Clinical indication and relevant signs/symptoms in the order or radiology report, 3) Prior imaging results when repeat studies are performed, 4) Comparison to less advanced modalities when appropriate (e.g., why MRI instead of X-ray), 5) Adherence to frequency limitations for screening studies, and 6) Documentation of failed conservative treatment when payer policies require it. For example, lumbar MRI for back pain often requires documentation of 6 weeks of conservative treatment failure. We educate ordering providers on documentation requirements, review orders for completeness before imaging, and ensure radiology reports include relevant clinical information supporting necessity.
How do you coordinate billing for teleradiology services?
Teleradiology billing coordination involves: 1) Tracking which radiologist read each study for proper professional billing, 2) Managing modifier 26 usage for all professional interpretations, 3) Coordinating with facility technical component billing to prevent conflicts, 4) Ensuring radiologists are properly credentialed and contracted with payers at each facility location, 5) Managing place of service codes based on where the radiologist was located during interpretation, 6) State medical licensure compliance for radiologists reading across state lines, and 7) Revenue reconciliation between professional billing and facility agreements. We use specialized radiology billing platforms that integrate with PACS systems to automatically capture study assignments, apply correct coding rules by facility, and generate comprehensive productivity and revenue reports.
Ready to Optimize Your Radiology Practice Revenue?
Partner with radiology billing specialists who understand component coding, interventional procedures, and complex imaging billing.