Radiology Billing Services

Radiology often involves multiple imaging modalities or multiple body areas in one session. Incorrect modifier usage can lead to payment reductions, duplicate claim denials, or compliance issues. Modifiers such as 26 (professional component), TC (technical component), and 59 (distinct procedural service) must be applied based on documentation and payer policy. Our team uses automated edits and manual reviews to apply modifiers correctly, protecting both compliance and revenue integrity.

Yes—but only under specific conditions. An E&M code can be billed if it occurs outside the global surgical period. Modifier 57 is used when pre-procedure decision-making leads to a major procedure. Modifier 25 applies if a distinct E&M service is separate from the interventional procedure. We review each case carefully to apply codes and modifiers correctly and defensibly.

No, injection of radiopharmaceuticals and technical tasks like venipuncture are bundled into nuclear CPT codes and not paid separately. Additional modifiers may apply for separate procedures on the same day.

We support seamless integration with EHR, RIS, and PACS systems via HL7/FHIR interfaces, enabling accurate charge capture and documentation flow. Our automation tools include RPA bots for ERA posting, denial triggers, and BI reporting dashboards for clean claim rates, AR aging, and denial trends.

We use a modern FHIR (Fast Healthcare Interoperability Resources)–based authorization engine to automatically submit and monitor payer requests. Real-time tracking flags delays or mismatches, typically reducing authorization-related rejections by around 40–45%. Specialist staff follow up when needed to ensure all required approvals are secured before service delivery.

Yes, we have experience in handling complex billing for both inpatient and outpatient settings. For hospital-based practices, we manage professional component billing to ensure physician payments are optimized. For office-based or freestanding imaging centers, we manage global billing that includes both technical and professional components. Our approach is customized to your practice size, payer mix, and service profile.

Payers often apply Multiple Procedure Payment Reduction (MPPR), which reduces reimbursement for secondary technical components by 50% and professional components by 5% when multiple imaging codes are billed together. We appeal incorrectly applied reductions, ensure proper use of modifiers (e.g., 59, XU), and validate that documentation supports separate sessions or medical necessity. Our denial management process focuses on quickly recovering revenue and preventing repeat issues.

CPT 37241 covers transcatheter therapy for non-vascular embolization procedures. Reimbursement accuracy depends on the correct coding of the procedure, documentation of medical necessity, and payer-specific rules. For Medicare and most commercial payers, the global code includes physician work, technical components, and post-procedure care. We track payer fee schedule updates, ensure proper use of modifiers for laterality or separate sessions, and validate claim alignment with the latest CMS and AMA guidelines to avoid underpayment or claim denials.

The National Correct Coding Initiative (NCCI) edits define which imaging procedures can and cannot be billed together. CMS added and revised edits for CT and MRI combinations, particularly when performed in the same session. For example, certain CT abdomen and pelvis combinations are bundled unless modifier 59 or XE is used to indicate distinct services. Our billing specialists review NCCI quarterly updates, apply the correct modifiers when services are clinically separate, and ensure compliance to prevent payer rejections or post-payment audits.

Our team ensures your diagnostic facility meets all CMS IDTF accreditation requirements, which is critical for Medicare and insurance reimbursement. We help maintain compliance with 42 CFR 410.33 performance standards, covering everything from credentialing and quality control protocols to accurate CPT/HCPCS coding for diagnostic imaging.

Our pricing for radiology medical billing services is customized to your practice’s size, service mix, and billing complexity. We offer flexible engagement models, including percentage-based, per-encounter, and dedicated full-time billing team options. Every plan is designed to be transparent, with no setup fees, hidden charges, or long-term lock-in contracts.