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Radiology Billing Services
Radiology billing is a two-component system — professional interpretation and technical acquisition — plus modality codes, prior auth for advanced imaging, and IR bundling that a generalist desk misses. Vector Medical Billing, in Jamaica, New York, assigns imaging coding to that specialty and runs the claim cycle inside the RIS or EHR you already use.
98%Published NCR
24hClaim Submission
BAASigned with every client
AAPCCertified coders
AHIMACertified coders
E&OErrors and omissions insured
50 StatesRemote billing nationwide
Monthly fee
What radiology billing services include
Full-cycle imaging RCM for radiology groups, freestanding imaging centers, IDTFs, and hospital-based professional reads — not a clinic E/M queue with a modality icon.
The operating cycle matches medical billing services: eligibility, prior auth when required, charge capture, ICD-10 / CPT coding, scrub, clearinghouse submission, payment posting, denial management, and A/R follow-up. The scrub watches professional vs technical splits, modality codes, contrast, NCCI bundling, laterality, and advanced-imaging auth.
In scope: diagnostic modalities (X-ray, CT, MRI, ultrasound, mammography, nuclear medicine, PET), interventional radiology professional claims, and teleradiology professional reads when the group bills them. Pure hospital facility UB-04 technical billing stays out unless separately agreed.
Radiology is priced as a percentage of net collections. Credentialing, a retrospective coding audit, MIPS, and out-of-network / IDR stay separate engagements.
What sits on this radiology fee
- 26 / TC / global logic matched to who owns the equipment and who reads the study
- Prior-auth and medical-necessity scrub for advanced imaging before the claim leaves
- RIS/PACS reconciliation so performed studies become claims — not silent misses
Where radiology claims fail
Denial patterns imaging RCM vendors and CMS PC/TC rules keep naming.
Wrong 26 / TC / global
Billing a global code when the practice only interpreted a hospital-owned study double-bills the technical piece. Billing 26 when the center owns the scanner understates the claim. Appending 26 or TC to a code that is already professional-only or technical-only is an automatic edit.
Vector reads site of service and equipment ownership before the modifier goes on.
Missing advanced-imaging auth
CT, MRI, PET, and many nuclear studies need prior authorization. Eligibility is not auth. A perfect CPT without the number — or with a CPT that does not match what was authorized — still denies.
Day-to-day auth tracking sits with claim readiness; high-volume auth queues can be scoped as prior authorization services.
Unbilled studies / bad IR bundling
RIS shows the study performed; the claim never left. Or IR injection and angiography S&I lines fight NCCI without vessel documentation. Both are revenue leaks before “coding skill” is even the issue.
Vector reconciles RIS/PACS to charges and holds IR stacks that the note cannot support.
26 · TC · global
Professional vs technical components
A professional read is not the facility’s technical charge. The two pieces are billed apart — or together as a global — when CMS PC/TC rules allow.
Modifier 26 = professional component only: supervision, interpretation, and a signed written report. Use it when the radiologist reads a study performed with facility-owned equipment.
Modifier TC = technical component only: equipment, supplies, and technologist time. Imaging centers and IDTFs bill TC (or global) when they own that piece.
Global (no 26/TC) = same entity provides both. Do not also bill 26 or TC on the same code for the same DOS. Hospital-based professional claims typically bill 26 only — the hospital owns the technical path on its own claim.
What the scrub checks
- CMS PC/TC indicator allows a 26/TC split on that CPT
- Written report exists before professional payment is claimed
- No global + component double-bill on the same study
Modality-specific coding
X-ray through PET — each modality carries its own CPT families, contrast rules, and payer edits.
X-ray, fluoro, ultrasound
View counts, complete vs limited ultrasound, and RT/LT laterality decide the code. Incomplete orders without medical necessity language stall payment even on “simple” radiographs.
CT, MRI, mammography
With/without contrast, multi-sequence MRI, and screening vs diagnostic mammography must match the protocol and the report. Prior auth is common on CT/MRI. Wrong contrast combination is a first-pass denial.
Nuclear medicine and PET
Radiopharmaceutical HCPCS, study CPT, and medical necessity policies are tight. PET and many NM studies need auth and LCD/NCD alignment. Missing the drug line or the auth number kills the claim.
Prior authorization and medical necessity
Advanced imaging fails upstream more often than it fails on CPT syntax.
Auth before the study
Commercial plans and Medicaid managed care commonly route CT, MRI, PET, and NM through radiology benefit managers. Auth must match CPT, site, and DOS. “No auth required” on a portal does not guarantee payment if the plan’s policy still demands medical necessity.
Vector holds claims that would leave without a required auth number and flags CPT mismatches against the approval.
Medical necessity and ABN
Diagnosis pointers must support the study under payer policy and LCD/NCD when Medicare applies. When Medicare may deny as not medically necessary and an ABN is appropriate, that workflow belongs upstream — not as a surprise after the remittance.
The free audit samples necessity denials and auth failures on your advanced-imaging mix.
IR · S&I · NCCI
Interventional radiology coding
Injection procedures and angiography supervision & interpretation are different CPT families — and NCCI watches how they stack.
Complete IR procedures should keep related injection and S&I lines on the same claim when they belong together. Selective catheter codes follow the highest-order vessel in that vascular family; lesser-order codes in the same family are typically bundled.
Modifier 59 (or applicable X{EPSU} modifiers) only when documentation supports a separate session, site, or lesion — not as a default unbundle. Modifier 52 can apply when only supervision or only interpretation of a radiology code is performed; it is not for injection codes under Noridian-style IR guidance.
IR scrub checks
- Vessel selection documented for selective catheter codes
- NCCI pairs reviewed before modifier 59 is applied
- Auth and medical necessity on high-dollar IR when required
Bundling, laterality, and multiple-procedure rules
High-volume imaging dies on edits that a specialty scrub is built to catch.
NCCI and contrast edits
Bundled combinations, with/without contrast pairs, and add-on rules differ by modality. Billing both a complete study and a limited study that is packaged inside it is a first-pass denial.
RT / LT / 76 / 77
Laterality and repeat-procedure modifiers (76 same physician, 77 different physician) must match the report. Wrong laterality is an automatic edit even when the CPT family is correct.
Multiple imaging reductions
Medicare and many commercials reduce the technical component when multiple applicable imaging services occur in the same session. Expectation vs remittance variance is an underpayment flag — not always a coding error.
RIS / PACS charge reconciliation
Every finalized study should end as a claim — or as a documented reason it cannot bill yet.
Missed-study control
Specialty radiology RCM treats RIS-to-billing reconciliation as a core control. Vector matches performed studies to charges so a completed CT does not age into a silent write-off because the charge never posted.
Teleradiology / multi-site
Professional reads across hospitals and night coverage need the correct rendering NPI, POS, and enrollment footprint. Multi-facility credentialing stays a separate credentialing project when paneling is the blocker — not a coding fix.
Radiology code families this service works
Illustrative anchors — the report, order, and payer policy decide the final claim.
| Work type | Example | What to check | Common failure if skipped |
|---|---|---|---|
| Professional / technical | 26 / TC / global | PC/TC indicator; ownership; written report | Global billed on hospital-owned equipment |
| X-ray / US / fluoro | Modality CPT by views / complete vs limited | Laterality; medical necessity | Wrong view count; missing RT/LT |
| CT / MRI | With / without / with-and-without contrast | Protocol vs report; prior auth | Auth CPT ≠ billed CPT |
| Mammography | Screening vs diagnostic | Order type; supplemental views | Screening billed as diagnostic (or reverse) |
| NM / PET | Study CPT + radiopharmaceutical HCPCS | Auth; LCD/NCD; drug units | Missing isotope line |
| Interventional | Catheter + angiography S&I families | Highest-order vessel; NCCI; same-claim completeness | Unbundled family codes; missing vessel docs |
| Repeat / distinct | 76 / 77 / 59 (when supported) | Same vs different physician; separate site/session | 59 used as default unbundle |
This page does not invent a radiology denial percentage. The free audit reads your 26/TC errors, auth denials, and missed-study rate on the sample you send.
What a free audit line looks like
Illustrative composite only — not a client result and not a promised recovery.
| Field | Example entry |
|---|---|
| Documented service | Hospital outpatient MRI brain with and without contrast; signed interpretation; commercial plan required auth for MRI; auth on file for without-contrast only |
| Billed code | Global MRI with-and-without CPT; no 26; auth number omitted |
| Issue found | Hospital-owned equipment → professional 26 only; billed CPT does not match authorized CPT; missing auth on claim |
| Recommended correction | Bill professional component with 26; align CPT to auth or obtain corrected auth before resubmit; place auth number on claim |
| Related check | Confirm study appears on RIS reconciliation and that contrast documentation supports the protocol billed |
| Why it matters | Component error + auth mismatch is a stacked first-pass denial — caught in scrub or flagged in the free audit |
Request a Free Audit with recent imaging claims, denials, and a RIS export sample. We map 26/TC, auth, and missed studies on your file — not this composite.
How Vector runs radiology billing
Specialty assignment and study reconciliation first — then the same revenue cycle.
1
Assign radiology
Coder and biller who already work 26/TC, modalities, auth, and IR edits.
2
Reconcile and code
Charge entry and coding from the report — queries when contrast or component is unclear.
Not inside the radiology percentage
Related work stays separate so the quote matches the job.
Credentialing
Provider credentialing across hospitals and teleradiology panels is a separate project — not a silent add-on.
Coding audit
A retrospective billing and coding audit of 26/TC and modality accuracy is scoped on its own when you want a period review.
Underpay / OON
Underpayment recovery and OON / IDR are separate when the dispute path is not ordinary denial work.
How radiology billing is priced
Percentage of dollars that land — not a flat fee per study that ignores auth denials.
Written rate
Radiology is priced as a percentage of net collections. No setup fee on the monthly cycle. Month to month. The written rate follows study volume, payer mix, and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
What we need to start
RIS/EHR access, modality mix, fee schedule or payer mix, open A/R if you are leaving another biller, and a sample of recent 26/TC or auth denials. Switching usually overlaps so claim submission does not stop. See EHR integration if access setup needs a separate quote.
Audit the imaging claims that are already failing
Send monthly study volume, top payers, RIS/EHR name, and a sample of component or auth denials. We reply with what the open A/R shows, whether the monthly fee fits, and a written rate — without inventing a clean-claim percentage.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
Radiology billing questions
Straight answers tied to the sections above.
What does radiology billing include?
Eligibility, prior authorization for advanced imaging, modality-specific CPT coding, professional and technical component billing with modifiers 26 and TC, NCCI scrub, claim submission, payment posting, denial management, A/R follow-up, and RIS/PACS charge reconciliation.
How much do radiology billing services cost?
The fee is a percentage of net collections. No setup fee on the monthly cycle. The written rate follows study volume and payer mix.
What is the difference between modifier 26 and TC?
26 = professional interpretation and report only. TC = technical equipment/staff/supplies only. Same entity providing both bills global with no 26/TC. Use the split only when the CMS PC/TC indicator allows it.
Do radiology claims need prior authorization?
Advanced imaging — CT, MRI, PET, and many nuclear medicine studies — commonly requires prior auth. Eligibility alone is not authorization. Auth CPT must match the billed CPT.
Do you bill interventional radiology?
Yes. IR needs vessel selection documentation, injection and S&I coding, NCCI review, and same-claim completeness for related components. Modifier 59 only when the note supports a separate component.
Do we have to change our RIS or EHR?
No. Billers work in the system you already use — see EHR integration. Compatibility is confirmed before you commit.
Where does Vector provide radiology billing?
The office is 15717 85th St, Jamaica, NY 11414-2620. Work is remote for radiology practices in all 50 states. See the specialties hub.
Is Vector Medical Billing HIPAA certified?
HHS does not certify billing companies. Vector signs a BAA, limits PHI to staff on the account, and follows HIPAA workflows. A HIPAA security risk analysis is a separate engagement when scoped.