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Specialty billing Radiology
Radiology billing built around modifier 26, modifier TC and global billing. One misapplied modifier can mean a denial, underpayment or later recoupment.
Radiology coding focus
The Core Problem
A radiologist reading a study, a facility hosting the equipment, and a referring physician ordering the scan each generate distinct billing obligations, and payers reject claims the moment those pieces don't line up. Global service billing, modifier 26 (professional component), and modifier TC (technical component) each require the coder to know exactly which party performed which function before a claim is ever submitted. Add modifier 59, modifier 76 for repeat procedures, and modifier 52 for reduced services, and the margin for error in imaging center billing services narrows fast. We work with imaging centers, hospital-affiliated radiology groups and teleradiology teams, using workflows built for imaging rather than adapted from generic medical billing. A wrong modifier can also lead to a duplicate payment that the payer later takes back.
Decision Tree
Modifier 26 applies when only the professional interpretation is billed, modifier TC applies when only the technical component (equipment, staff, supplies) is billed, and global billing applies when one entity performs and bills both. Take CPT 70551 (MRI brain without contrast): a freestanding imaging center that owns the scanner and employs the reading radiologist bills globally. When a hospital owns the scanner, the hospital bills the technical side and the radiologist bills 70551-26. Our coders make this call before submission, not after a denial arrives.
For the reading radiologist when another party owns the scanner.
For the scanner owner when another party reads the study.
When one entity owns the equipment and reads the study.
From January 1, 2026, imaging interpretations are among the non-time-based services subject to the -2.5% efficiency adjustment to work RVUs in CMS's CY 2026 Medicare Physician Fee Schedule final rule. We compare your payments with the 2026 rates, so underpaid reads stand out.
Source: CMS, CY 2026 PFS final rule fact sheet (October 31, 2025).
Sub-Specialty Coding
A study done with contrast needs the "with contrast" CPT code, and the documentation must support it. Whether the contrast agent itself is billed separately with a HCPCS Level II code depends on the setting and the payer. In hospital outpatient billing, for example, Medicare folds the agent's payment into the imaging service. In interventional radiology (IR), many procedures already include imaging guidance, and National Correct Coding Initiative (NCCI) edits bundle the two; moderate sedation follows its own reporting rules. Our coders review IR claims against these rules before submission.
Our Process
Ask about our modifier 26/TC determination workflow and how we handle NCCI bundling for interventional radiology.
Book a Free ConsultationOrder, scan and interpretation details taken from your systems and the signed report
Modifier determination (26 / TC / global) and POS validation against the technical facility
NCCI bundling edits checked before submission
Clean claim submitted with full documentation trail
Denials worked by staff who know radiology modifiers and POS rules, sorted by root cause
Regular review of how each payer handles your modifiers and POS codes, so changes are caught early
Results-Driven
We show you the exact workflow rather than a number without context. Radiology denials often come back with modifier or POS reasons, and they need someone who reads them as radiology problems, not generic rejections. That's the gap this workflow is built to close.
Trust & Compliance
MedixCode is HIPAA compliant, and our staff are HIPAA-trained. We work inside the systems your imaging group already uses, with the access your team grants, and your data stays yours. For teleradiology groups reading across state lines, our credentialing service can handle payer enrollment for each reading radiologist.
Clear Pricing
You pay a percentage of net collections. There's no setup fee and no monthly minimum, and we confirm your rate in writing after we learn your mix of global, professional-only and teleradiology work. See how pricing works
Seamless Onboarding
Switching radiology billing vendors is a real operational risk if it's not sequenced correctly, which is why our transition plan runs credentialing continuity, claims handoff, and denial workflow migration in parallel rather than in sequence. For imaging centers, that means active claims stay in motion while new submissions move to our workflow. For teleradiology groups, that means multi-state credentialing status is verified before the first claim under our management goes out the door, so read volume keeps moving without claims getting ahead of enrollment.
FAQ
Answers on modifiers, place of service, contrast and onboarding. More questions? See our FAQ
Use modifier 26 when you're billing only the professional interpretation and someone else owns the equipment. Use modifier TC when you're billing only the technical component and someone else is reading the study. Bill globally only if you perform both.
Bill modifier 26 with the place of service code for the hospital where the scan was performed, not the radiologist's home or reading center location. Medicare's rule is that POS for the professional component is the setting where the patient received the technical component.
Use the POS code of the setting where the patient physically received the imaging study. The radiologist's remote location doesn't determine POS on a professional-component claim.
No. Clean claim rate depends on payer mix and study type, so a single blended number wouldn't reflect your practice. In the consultation, we'll go through your own read and modifier data with you.
Yes. Our AAPC/CPC Certified Coders and Billers know the NCCI bundling rules between imaging guidance and interventional procedures, plus the separate reporting rules for moderate sedation.
When contrast is given, we code the 'with contrast' version of the study. Whether the contrast agent is billed separately depends on the setting and payer: in the hospital outpatient setting, Medicare packages contrast agents into the imaging payment.
Yes. Our credentialing service handles payer enrollment for each radiologist, so claims don't go out before enrollment is active.
We set the start date with you once we know your systems, data access and which payers your global, professional-only and teleradiology claims go to. Then we plan the handoff so billing can continue during the switch.
Get Started
Book a free consultation and see how our modifier-first workflow helps close the gap between what you earn and what you collect.
Imaging groups can also write to info@medixcode.com.
