High volume, read by one party, owned by another
Radiology billing runs on volume: thousands of studies a month, each with an order, a report and a diagnosis supplied mostly by someone else — the ordering clinician. Radiologists often read images taken on equipment owned by a hospital or imaging center, so who bills which part of a study depends on contracts and ownership. Missing or vague clinical indications from the order are the single biggest source of radiology denials.
Professional and technical components
| Who bills | Modifier | Covers |
|---|---|---|
| Radiologist reading for a hospital or another owner | 26 | Interpretation and report |
| Owner of the equipment (hospital outpatient, imaging center) | TC | Equipment, staff, supplies and facility costs |
| Practice that owns the equipment and reads the study | None (global) | Both components |
In hospital settings the hospital bills the technical part on its own claim, and the radiology group bills only the professional component. Billing globally when the group does not own the equipment is a compliance risk, not just a denial.
Coding from the report
- With and without contrast: CT and MRI codes depend on whether contrast was used and in which sequence; contrast agents are billed separately where the payer allows.
- Diagnosis: when a study is read, confirmed findings are coded; otherwise the signs and symptoms that led to the order are coded — never “rule out” conditions.
- Multiple studies: Medicare reduces payment for the professional and technical components of certain advanced imaging studies performed in the same session, and the lines are ordered so the reduction is applied correctly.
- Screening versus diagnostic mammography: screening (77067) and diagnostic mammography (77065, 77066) have different codes, coverage and patient cost-sharing, and tomosynthesis is reported with its own codes.
Authorizations and orders
Most commercial and Medicare Advantage plans require prior authorization for advanced imaging — CT, MRI, PET and nuclear studies — usually through a radiology benefit manager. Authorization is the ordering practice’s responsibility, but the radiology claim is denied when it is missing or does not match the study performed, so checks happen at scheduling. Medicare’s appropriate use criteria program for advanced imaging has been paused since 2024, so that information is no longer required on Medicare claims.
Interventional radiology
Interventional procedures — biopsies, drainages, vascular access, embolizations and venous procedures — are coded by approach, vessel or organ and the imaging guidance included in the code. Catheter placement follows vascular family rules, and many procedures carry global periods. See medical coding services.