Radiology RCM

Radiology & Imaging Billing Services

High-volume, high-accuracy billing for every imaging modality — from plain films to interventional procedures — with expert TC/PC split management and multi-facility support.

99.4% TC/PC Split Billing Accuracy

12+ Imaging Modalities Supported

$3.6M Avg. Revenue Recovered per Group

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The Challenge

Why Radiology Billing Requires Specialized Knowledge

Radiology practices process thousands of claims monthly across multiple modalities, facilities, and reading arrangements. A single percentage point improvement in clean claim rate translates to hundreds of thousands in recovered revenue.

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TC/PC Split Complexity

Correctly splitting technical and professional components across different billing entities is the foundation of radiology billing. We manage modifier -26 (professional), -TC (technical), and global billing based on ownership, lease arrangements, and reading contracts.

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Multi-Modality Coding

From X-ray and CT to MRI, ultrasound, PET, nuclear medicine, mammography, and fluoroscopy — each modality has unique coding rules, supervision requirements, and medical necessity documentation standards.

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Interventional Radiology

IR procedures combine imaging guidance with invasive techniques — requiring correct coding of both the intervention and the imaging component, with proper understanding of when imaging is bundled into the primary procedure vs. separately billable.

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MPPR & Volume Reductions

Multiple Procedure Payment Reduction rules reduce TC payments by 50% on the second and subsequent procedures in the same session. We optimize claim ordering and session documentation to minimize MPPR impact on total reimbursement.

Core Competency

Technical vs. Professional Component Mastery

The TC/PC split is the single most important billing concept in radiology — and the most common source of errors. Incorrect split billing results in duplicate denials, underpayments, and compliance risk.

Ownership-based routing — determining whether the practice bills global, -26 only, or -TC based on equipment ownership and facility contracts
Multi-site management — handling different billing arrangements across hospital contracts, imaging center ownership, and office-based equipment
Anti-markup rule compliance — ensuring reassigned purchased interpretations comply with CMS anti-markup provisions
Supervision level verification — confirming that general, direct, or personal supervision requirements are documented for each study type
Place of service accuracy — correct POS coding (11, 19, 22, 24) that matches the TC/PC billing arrangement

Contrast Coding

Getting Contrast Coding Right

Contrast administration coding is a frequent source of denials and underpayment in radiology. The rules vary by modality, payer, and whether oral, IV, or intrathecal contrast is used.

CT contrast differentiation — without contrast, with contrast, and with/without are distinct CPT codes with significant reimbursement differences
MRI contrast protocols — proper coding of pre- and post-gadolinium sequences and ensuring medical necessity documentation supports contrast use
Injection coding — knowing when contrast injection (e.g., 36000, Q9965-Q9967) is separately billable vs. included in the imaging code
Oral contrast supply — capturing HCPCS supply codes for oral contrast administration when applicable

Revenue Impact

Correct contrast coding alone can recover significant revenue. A with/without CT abdomen reimburses 40-60% more than a without-contrast study. Ensuring proper protocol documentation and code selection captures this difference on every applicable exam.

FAQ

Radiology Billing Questions Answered

We manage professional component billing for teleradiology groups reading across multiple facilities. This includes correct credentialing at each rendering location, place of service coding, anti-markup rule compliance for purchased interpretations, and NPI routing for group vs. individual billing arrangements.

We optimize claim ordering to ensure the highest-RVU procedure is listed as the primary service, minimizing the 50% TC reduction applied to subsequent procedures. We also analyze scheduling patterns to identify opportunities to separate sessions when clinically appropriate and properly documented.

Yes, we integrate with all major RIS and PACS systems. Our charge capture process reconciles orders in the RIS against completed studies in PACS, ensuring no exam goes unbilled. We flag discrepancies between ordered and performed studies for radiologist review before claim submission.

IR coding requires understanding both the interventional procedure and the imaging guidance. We code vascular access procedures, embolization, drainage, biopsies, and ablations with correct S&I (supervision and interpretation) codes when applicable, and know when imaging is bundled into the procedure code vs. separately reportable.

We manage prior auth for CT, MRI, PET, and nuclear medicine studies across all major radiology benefit managers (eviCore, AIM, NIA). Our team submits clinical documentation proactively, tracks approval status, and appeals denied authorizations with supporting clinical evidence.

We handle screening vs. diagnostic mammography coding, 3D tomosynthesis add-on billing, CAD (computer-aided detection) codes, breast ultrasound and MRI, and the transition to updated mammography CPT codes. We also manage MQSA compliance documentation and ensure proper screening benefit application to eliminate patient balance billing on covered screening exams.