Specialty billing / Radiology
Radiology revenue depends on getting the component split right on every claim. The same study can be billed globally, professionally, or technically, and which applies depends on who owns the equipment and where the read happened. Layer on advanced imaging authorization requirements and high daily volume, and small systematic errors compound quickly.
0
Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
Where it breaks
Modifier 26 covers the interpretation and TC covers equipment, staff and supplies. Hospital-based reads billed globally, or office studies billed with modifier 26 only, create denials and underpayments that repeat on every claim until the template is corrected.
CT, MRI, PET and nuclear studies almost always require authorization, and the burden usually falls on the ordering provider. When imaging centers perform studies before confirming approval, the claim is unrecoverable and the patient is caught in the middle.
The diagnosis on the order frequently fails to support coverage for the study performed. Reading radiologists document findings rather than indications, so the claim carries a reason that does not satisfy the payer's policy.
Codes distinguish studies performed without contrast, with contrast, and without followed by with. The report must state which was performed. Ambiguous reports force a conservative code that under-reports the work done.
Frequently billed
Representative codes only. Actual coding follows current CPT/HCPCS guidance and payer policy.
Denials we prevent
FAQ
Modifier 26 reports the physician's interpretation and written report when someone else owns the equipment, typically a hospital-based read. TC reports the equipment, technologist and supplies when a facility performs the study but does not interpret it. Bill globally with neither modifier only when your practice performs and interprets the study.
The ordering provider usually initiates it, but the imaging center bears the financial loss when it is missing. The practical safeguard is verifying that an authorization exists and matches the modality and body part before the patient is scanned. Confirming after the study leaves no remedy if approval was never obtained.
Because the diagnosis on the order does not meet the payer's coverage policy for that study. Radiology reports document findings, not indications, so the claim carries whatever the ordering provider supplied. Reviewing orders against policy before the study, and querying the referrer when the indication is thin, prevents most of these denials.
The report must state whether the study was performed without contrast, with contrast, or without followed by with, because each maps to a different code and a different payment. Oral contrast alone generally does not qualify as with contrast for CT. When the report is ambiguous, the conservative code is assigned and revenue is lost.
Yes. Radiology is a volume business, so the priority is consistent same-cycle submission and automated reconciliation rather than manual handling of each claim. We file within 48 hours of receiving reports and reconcile studies performed against claims submitted, so missing charges are caught within days instead of at month end.
Other specialties
Next step
Send us your specialty, claim volume and current billing setup. We will come back with a proposal you can act on.
