Radiology billing requires precise management of the technical/professional component split, teleradiology billing rules, prior authorization for advanced imaging, and RVU-based compensation modeling. Errors in TC/26 modifier application can result in double-billing risk or systematic under-collection.
Common Billing Challenges
These are the billing failure points we see most often in radiology practices — and the ones our team resolves systematically from day one.
Radiology codes often split into technical component (modifier TC — the equipment and technologist) and professional component (modifier 26 — the radiologist's interpretation). When a hospital owns the equipment and a radiologist owns only the interpretation, billing without modifier 26 results in overpayment claims.
When a practice owns both the equipment and employs the radiologist, the global code (no modifier) is correct. Incorrectly splitting global codes into TC + 26 components when both are owned by the same entity is an OIG audit trigger.
CT (70450-70553), MRI (70540-70559), and PET scans (78811-78816) require prior authorization from most commercial payers — with the ordering physician's clinical indication and ICD-10 codes. Radiology groups that don't manage auth on the front-end before performing studies risk 100% denial exposure.
Studies performed with contrast must be documented as either "with contrast" (separate code) or "without and with contrast" (global code). Billing "without contrast" when contrast was given, or vice versa, triggers systematic denials and audit risk.
Radiologists reading studies across state lines via teleradiology must be licensed in the state where the patient received care — not where the radiologist is physically located. Medicare Conditions of Participation and state medical board rules apply. Billing for unlicensed teleradiology interpretations is a compliance violation.
Radiology reimbursement is RVU-driven. Systematic selection of lower-complexity codes when higher-complexity studies were performed (e.g., limited CT when a complete multi-sequence study was done) is the most common value capture failure in radiology groups.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in radiology.
| CPT Code | Description | Common Issue |
|---|---|---|
| 70553 | MRI brain with/without contrast | Highest-value neuroimaging; prior auth required most payers |
| 74178 | CT abdomen/pelvis with contrast | Most common CT combination; prior auth required |
| 78816 | PET scan, whole body | Prior auth required; metabolic activity documentation |
| 71250 | CT thorax without contrast | Modifier 26 if radiologist doesn't own equipment |
| 93306 | Echo, complete with Doppler | TC/26 split frequent in cardiology/echo lab settings |
| 77067 | Screening mammography | No auth required; bilateral code; separate from diagnostic |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Our billing system applies the correct modifier for every study based on ownership structure — global, TC, or 26 — preventing both over- and under-collection.
Prior authorization management for CT, MRI, and PET with complete clinical indication packages — reducing the auth-related denial rate that affects 35% of advanced imaging claims.
Systematic contrast usage documentation ensures the correct code variant is billed — eliminating the "with/without" mismatch that triggers payer audits.
Interstate licensing verification for teleradiology interpretations — ensuring compliance with state medical board and Medicare billing requirements.
Quarterly coding audits identify systematic code selection below the documented complexity level — the highest-value per-RVU correction in radiology groups.
Post-procedural imaging within global surgery periods is tracked and billed with correct modifiers — capturing the full technical and professional value.
Straight answers to what practices usually ask before they switch.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.