Radiology Medical Billing Services
Radiology billing depends on information generated by someone else. The ordering provider writes the indication, and if that indication does not meet the payer's criteria, the denial arrives at your practice rather than theirs.
Codes this specialty bills most
| Code | Description | Watch for |
|---|---|---|
| 70450 | CT of the head or brain without contrast | Denies where the indication does not meet the payer's coverage criteria. |
| 71271 | CT of the thorax, low dose, for lung cancer screening | Screening code with strict eligibility criteria on age and smoking history. |
| 77067 | Screening mammography, bilateral, with computer aided detection when performed | Frequency limited. An early claim denies. |
| 76700 | Ultrasound of the abdomen, complete | A complete study requires all required elements to be documented, otherwise the limited code applies. |
The denials this specialty sees
Component splitting is the first thing to check on any radiology account. Modifier 26 is the professional component and TC is the technical. A practice that only interprets and bills globally is overbilling; one that performs both and bills only the professional component is leaving half the payment behind. Neither necessarily denies, which is why both persist.
The second pattern is the one radiology practices cannot control directly. Coverage decisions rest on the clinical indication supplied by the ordering provider, and a referral saying "rule out pathology" will not meet anyone's criteria. The denial still arrives at your practice. See CO-50.
The practical fix is upstream: give referring practices an order template that asks for what the payer actually requires.
Third is authorization. Advanced imaging almost always requires it, frequently through a third party benefit manager, and obtaining it after the study is done rarely rescues the claim.
Our billing team audits component usage on the first month of a radiology account, because that error is systematic when it exists.
Payer notes
Lung cancer screening has specific eligibility criteria covering age and smoking history, along with a shared decision making visit requirement. Claims failing any element deny.
Many payers delegate advanced imaging authorization to a radiology benefit manager with its own criteria, which may be stricter than the plan's published medical policy.
Common questions
Should we bill globally or with modifier 26?
It depends on what your practice performed. Modifier 26 is the interpretation alone. TC is the equipment and technologist. Bill globally only when you provided both. Getting this wrong usually pays wrong rather than denying, so it can persist for years.
How do we reduce denials caused by referral indications?
Work upstream. Give your referring practices an order form that asks for the specific clinical findings the payers require. It is more effective than appealing individual claims, because the same referral pattern produces the same denial next month.
Can we appeal a denial for missing prior authorization?
Occasionally, where the study was genuinely urgent or the payer's own process failed. As a rule, retroactive authorization is not granted, so the effort is better spent on verification before the study.
See what your claims are leaving behind
Send us a month of remittance data and we will tell you what it says: which codes are being denied, how much of it is recoverable, and how long your money is sitting in A/R. It takes about a week and there is nothing to sign.