Radiology Medical Billing & Credentialing Services

Radiology billing requires specialized expertise in complex component coding, distinguishing technical from professional services, and navigating strict documentation standards that general medical billing services cannot adequately address. Radiology practices including diagnostic imaging centers, interventional radiology clinics, teleradiology providers, and hospital-based radiology departments face unique revenue cycle challenges such as frequent claim denials, evolving prior authorization requirements, varying payer policies regarding global versus split billing, and intricate modifier applications affecting reimbursement sustainability.

Pro Health Care Advisors delivers comprehensive radiology billing solutions designed for small to mid-sized imaging practices seeking accurate claims processing, reduced denial rates, improved cash flow, and expert guidance navigating the evolving regulatory landscape governing diagnostic and interventional radiology services reimbursement.

Understanding Radiology Billing Complexities

Radiology billing differs substantially from other medical specialties due to component-based coding distinguishing technical components including equipment, supplies, and technologist services from professional components covering physician interpretation and report generation that directly determine reimbursement approval or denial. Global radiology codes bundle both technical and professional components requiring modifier 26 for professional component only billing or modifier TC for technical component only billing when services split between different providers or facilities.​​

Radiology practices experienced 2.9% Medicare reimbursement reductions in 2025, creating tighter margins requiring precise billing practices maximizing legitimate reimbursement without audit vulnerability. Pro Health Care Advisors implements systematic quality assurance protocols identifying documentation gaps, coding mismatches between radiologic guidance and primary procedures, missing modifier applications for bilateral imaging or multiple anatomical sites, and incomplete prior authorization documentation before claim submission, preventing costly denials and compliance vulnerabilities.

Comprehensive Billing Services for Radiology Providers

Expert Coding for Diagnostic Imaging Procedures

Our specialists ensure accurate code selection for chest X-rays using 71010-71035, CT scans coded 70450-74177 based on anatomical region and contrast administration, MRI procedures using 70540-73725 with proper distinction between with-contrast, without-contrast, and combined sequences requiring separate code assignment.

Radiologic Guidance and Interventional Procedure Billing

Radiologic guidance codes 77001-77022 require proper pairing with primary procedures, understanding bundling restrictions preventing separate billing when guidance included in comprehensive procedure codes, and documentation demonstrating separate image guidance medical necessity supporting additional reimbursement.

Component Billing with Modifier 26 and TC Application

Pro Health Care Advisors manages split billing scenarios applying modifier 26 when radiologists provide interpretation services only without equipment ownership, modifier TC when facilities provide technical components without physician interpretation, and global billing without modifiers when single entity provides complete service.​​

Teleradiology Compliance and Anti-Markup Rule Navigation

Teleradiology billing demands strict compliance with anti-markup rules limiting reimbursement when ordering physicians differ from interpreting radiologists, requiring separate line-item billing for technical and professional components, proper NPI reporting for physicians performing reads, and credentialing in Medicare Administrative Contractor jurisdictions where interpretations occur.

Strategic Denial Management Reducing Revenue Loss

Radiology practices experience substantially higher denial rates than many specialties due to missing prior authorizations for advanced imaging including MRI and CT scans, insufficient medical necessity documentation supporting diagnostic imaging orders, incorrect component modifier usage, and claims submitted without proper referring physician information. Common denial triggers include services bundled under primary procedure codes billed separately without appropriate modifiers, procedures exceeding frequency limitations established by payer medical policies, laterality modifier omissions causing claim rejections, and radiology reports lacking required elements supporting billed complexity levels.

Our denial management system tracks patterns specific to radiology billing including National Correct Coding Initiative edits affecting guidance code bundling, documentation insufficient for medical necessity justification under appropriateness criteria, and payment disputes regarding modifier 59 application for distinct procedural services performed same session. We implement corrective action plans addressing root causes, pursue appeals with payer-specific imaging documentation supporting medical necessity and proper component billing distinctions, and monitor first-pass resolution rates measuring revenue cycle efficiency.

Revenue Cycle Solutions Beyond Claims Submission

Prior Authorization Management for Advanced Imaging Services

CMS and commercial insurers tightened prior authorization requirements in 2025 for complex imaging services including MRI, CT scans, and nuclear medicine studies requiring pre-approval before service delivery. Authorization delays postpone diagnostic procedures while disrupting patient care continuity, requiring systematic tracking systems monitoring approval status, clinical decision support integration, and expedited appeal processes for urgent diagnostic needs.​

Split Billing Coordination Between Facilities and Physicians

Hospital-based radiology practices frequently split technical and professional components between facility billing departments and physician groups creating coordination challenges. Pro Health Care Advisors implements systematic communication protocols ensuring proper modifier application, preventing duplicate billing violations, and coordinating claim timing between entities maximizing reimbursement while maintaining compliance.​

HIPAA Compliance for Teleradiology Platforms

Telehealth service billing requires strict HIPAA compliance for video technologies transmitting protected health information during remote consultations. Documentation must include patient consent for teleradiology services, secure platform specifications meeting encryption standards, and detailed service records supporting billing accuracy preventing payer disputes regarding remote interpretation legitimacy.​

2025 CPT and Quality Payment Program Requirements

Annual CPT coding updates introduce new radiology codes, revised guidance code definitions, and updated ultrasound procedure classifications requiring continuous education. Quality Payment Program participation mandates outcome reporting including dose optimization metrics, appropriateness criteria adherence rates, and radiation exposure minimization documentation affecting Medicare payment adjustments through Merit-Based Incentive Payment System scoring.

Partner with Specialized Radiology Billing Experts

Radiology billing complexity demands dedicated expertise understanding component coding nuances, prior authorization protocols, and evolving payer policies affecting diagnostic and interventional imaging services reimbursement.

Our specialized radiology billing services deliver:

• Expert component coding accuracy with proper modifier 26 and TC application
• Prior authorization management for advanced imaging including MRI and CT scans
• Radiologic guidance billing optimization understanding bundling restrictions
• Teleradiology compliance including anti-markup rule navigation
• Split billing coordination between facilities and physician groups
• HIPAA-compliant systems protecting patient health information
• Denial management addressing radiology-specific rejection patterns
• Monthly financial reporting with quality metric tracking supporting MIPS

Pro Health Care Advisors brings boutique service quality ensuring your billing team understands radiology practice workflows, knows your payer mix challenges intimately, and advocates persistently for maximum reimbursement on every diagnostic and interventional imaging service.