Specialty billing
Radiology Medical Billing Services
Radiology billing is dominated by the split between the technical component (equipment and staff) and the professional component (the radiologist's interpretation). Getting that attribution wrong is the defining error of the specialty, and it is systematic rather than occasional when the billing process does not model it explicitly.
Radiology benchmarks
- Typical denial rate
- 10–16%
- Days in AR
- 32–45
- Achievable clean claim rate
- 97%+
Typical ranges for radiology groups. Your actual numbers are measured during the audit.
The complexity
Why radiology is uniquely difficult to bill
Nearly every study splits into technical and professional components
Global billing applies only when one entity owns both equipment and interpretation
Contrast studies carry distinct codes from non-contrast versions of the same study
Advanced imaging requires prior authorization from most commercial payers
Multiple procedure payment reduction applies to imaging performed in the same session
Reading location and place of service affect which component is billable
Coding
Radiology procedure codes we work with daily
A representative sample, not an exhaustive list. Coders are assigned by specialty rather than pooled.
| Code | Description |
|---|---|
| 71046 | Radiologic examination, chest, two views |
| 74177 | CT abdomen and pelvis with contrast |
| 72148 | MRI lumbar spine without contrast |
| 76700 | Ultrasound, abdominal, complete |
| 77067 | Screening mammography, bilateral, with CAD |
| 70450 | CT head or brain without contrast |
Revenue leakage
Where radiology practices lose money
These are the denial patterns specific to this specialty — the ones a general-purpose billing service will not be looking for.
Component attribution errors
Global billing submitted where only the professional component is owned, or modifiers 26 and TC applied to the wrong party.
Missing prior authorization
CT, MRI and PET denied because the payer required authorization that was not obtained or not referenced on the claim.
Contrast coding errors
With-contrast codes billed where contrast was not administered, or the without-contrast code used when contrast was given.
Medical necessity
Advanced imaging denied where the diagnosis code does not meet the payer's coverage policy for that study.
Multiple procedure reduction
Expected full payment on multiple same-session studies where payer reduction rules apply to the technical component.
Payer landscape
What radiology groups need to know about payers
Payer policy drives more radiology denials than coding does. Knowing the policy before the service is what prevents them.
- Most commercial payers route advanced imaging authorization through a radiology benefit manager with its own criteria.
- Screening versus diagnostic mammography changes both the code and patient cost-sharing under preventive care rules.
- Reading studies performed at an outside facility means only the professional component is billable by the group.
Questions
Radiology billing FAQ
Last updated August 20, 2026
Reviewed by a certified coding leadGlobal billing covers both the equipment and staff (technical component) and the radiologist's interpretation (professional component), and is appropriate only when one entity owns both. When the study is performed at a facility and read by an outside group, the facility bills the technical component with modifier TC and the group bills the professional component with modifier 26.
Because most commercial payers delegate advanced imaging authorization to a radiology benefit manager applying its own coverage criteria, and the ordering physician — not the radiology group — usually obtains it. The group performs the study and discovers the authorization gap only when the claim denies.
With-contrast and without-contrast versions of the same study are distinct codes, and some studies have a third code for both. The code must match what was actually administered. Mismatches between the order, the technologist's record and the claim are a persistent denial source.
When several imaging studies are performed in the same session, payers reduce payment on the technical component of subsequent studies, on the reasoning that setup and overhead are shared. Expecting full payment on every study produces an apparent underpayment that is actually correct adjudication.
Primary sources
Coverage, rates and local policy for radiology, at the source.
- Medicare Physician Fee Schedule lookup (opens in a new tab)
Centers for Medicare & Medicaid Services — Official allowed amounts by CPT/HCPCS code and locality. The reference point most commercial contracts are written against as a percentage.
- NCCI Policy Manual for Medicare Services (opens in a new tab)
Centers for Medicare & Medicaid Services — The reasoning behind the edits, chapter by chapter. Where the edit files tell you two codes conflict, this explains why — which is what an appeal has to address.
- Medicare Coverage Database (LCD/NCD) (opens in a new tab)
Centers for Medicare & Medicaid Services — Searchable national and local coverage determinations. The direct answer to whether a diagnosis supports medical necessity for a given procedure.
Get a free radiology billing audit
We'll review your radiology denial patterns, coding accuracy and AR aging against the benchmarks above. Takes about two minutes to request.
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