Radiology billing services start with the order
Radiology billing services depend on details the practice does not create. The order, the diagnosis and the ordering provider come from another office, and the radiologist may never see the patient. If any of those details is missing or does not match the study, the claim fails even when the read was done correctly.
Fastora handles radiology medical billing for reading groups, imaging centers and teleradiology practices, with certified billers and coders reviewing each claim. The work builds on our core medical billing services: eligibility, coding, claim submission, payment posting and follow-up.
Eligibility and prior authorization for advanced imaging
We verify eligibility from the order before the study and flag high-deductible plans so patients know their share. Many commercial and Medicare Advantage plans require prior authorization for advanced imaging, such as CT, MRI, PET and nuclear medicine, often through a radiology benefit manager.
The approval is tied to the exact CPT code, so a switch from a non-contrast study to a with-and-without contrast study needs an update before the claim is billed. Our authorization team checks each approval against the performed study and the place of service.
For traditional Medicare, CMS paused the Appropriate Use Criteria program for advanced imaging and rescinded its regulations effective January 1, 2024, and says AUC consultation information should no longer be included on Medicare fee-for-service claims. Commercial and Medicare Advantage plans still apply their own authorization programs.
Codes and rules specific to radiology coding
Radiology coding turns on two questions: which component did the practice provide, and does the code match the study as performed, including body area, laterality and contrast?
| Billing | When it applies |
|---|---|
| Global (no modifier) | The same entity owns the equipment, performs the study and interprets it |
| Modifier 26 | Professional component only: the radiologist's interpretation and written report |
| Modifier TC | Technical component only: equipment, technologist and supplies |
| Modifiers RT / LT / 50 | Right side, left side or bilateral procedure, where the code does not already describe it |
Mammography codes and screening-to-diagnostic changes
| Code | Descriptor (summary) |
|---|---|
| 77067 | Screening mammography, bilateral, including computer-aided detection when performed |
| 77063 | Screening digital breast tomosynthesis, bilateral (add-on to the screening mammogram) |
| 77065 / 77066 | Diagnostic mammography, including computer-aided detection when performed: unilateral / bilateral |
| G0279 | Diagnostic digital breast tomosynthesis (Medicare HCPCS code reported with diagnostic mammography) |
When a screening exam leads to additional views the same day, a Medicare contractor billing article directs that the abnormality be documented and modifier GG be added to the diagnostic mammogram line. The change can also shift the patient's cost sharing, so the front desk should be ready to explain it.
Contrast and multiple studies
Contrast status must match the order, the authorization and the report. Payers that pay contrast separately expect the supply code on the technical claim, and many apply multiple procedure payment reductions when several imaging studies are done in one session. NCCI edits also bundle some image guidance into the primary procedure, so we check edits before release.
Imaging center billing and teleradiology billing
Imaging center billing
Imaging center billing usually means the center bills the technical component or the global service, while an outside group may bill the professional read. Medicare pays the technical component under the physician fee schedule for patients seen in a physician's office or a freestanding imaging center, but not for hospital inpatients, whose technical component is paid to the hospital. We confirm which entity bills each component before the first claim goes out.
Teleradiology billing
Teleradiology billing is professional-component billing with extra enrollment checks. The reading radiologist is generally billed with modifier 26 under the group that employs or contracts with them, and each radiologist needs to be licensed where payers and states require and enrolled with the payers the group bills. Where a practice bills for an interpretation it purchased from an outside physician, Medicare's anti-markup rule limits payment, so these arrangements need review before billing.
Common denials and how we prevent them
Most radiology billing denials trace back to the order or the component. We fix the source, not only the claim, and appeal through our denial management workflow with the order and report attached.
| Denial pattern | Prevention step |
|---|---|
| Performed study differs from the authorized study | Compare the report with the approval and request an update before billing |
| Diagnosis does not support medical necessity | Check the order's diagnosis against the payer policy and query the ordering office |
| Missing or invalid ordering provider NPI | Validate the ordering provider at scheduling |
| Global billed when another entity owns the equipment | Confirm site ownership and bill with modifier 26 or TC |
| Laterality or contrast mismatch | Compare modifiers and code with the order and report during claim review |
Split billing means two payments for one study, so we reconcile each component in payment posting and follow up on the missing half. Patient balances from high-deductible plans are sent promptly with the ordering provider and facility named, since patients often do not recognize the group that read their study.
Credentialing for radiology groups
Radiologists are often enrolled with many payers and, for teleradiology groups, in several states at once. Each enrollment needs the correct group reassignment and practice locations, or professional claims are denied for an unenrolled rendering provider. Fastora tracks payer enrollment through a nine-stage process, from document collection, licensing and CAQH setup to payer applications, panel submissions and final approval.
How Fastora supports radiology medical billing
Each practice has a dedicated account contact, a transparent dashboard and a monthly review call covering denials, authorization gaps and component-level AR. We sign a Business Associate Agreement before accessing PHI and work under the user access your practice grants. A free billing assessment reviews a sample of your claims before you commit to anything, and pricing is quoted after that review.
Imaging groups working with hospital departments also encounter pathology billing, oncology billing and obstetrics and gynecology billing when global and professional-component rules interact.
Teleradiology billing: reading location and rendering vs billing provider. The reading location matters: Medicare generally prices the interpretation based on where it is performed, so the place of service and the radiologist enrollment have to line up. On the claim, the rendering provider is the radiologist who read the study; the billing provider is the group submitting the claim. When those sit in different states, each radiologist needs the right licenses and payer enrollments — we check both before the first claim goes out.
A radiology billing company for imaging practices and groups
As a radiology billing company, we run billing for diagnostic imaging centers, hospital radiology departments and independent reading groups. Modality coding across CT, MRI, ultrasound and x-ray is checked against the report before claims go out, technical and professional components are split correctly, and pre-authorization is confirmed for the high-cost studies that payers audit. Global billing vs component billing is set per payer contract so each claim pays at the contracted rate. Related: pathology billing, denial management, free medical billing audit.