Diagnostic Imaging — Every Scan, Every Read, Every Dollar

Proven Results

• 21.5% Revenue Increase
• 98.2% First-Pass Claim Rate
• 37.5% Faster Reimbursement
• 99.8% Policy Compliance

Common Billing Challenges

Complex Modifier Requirements

Telehealth billing requires specific modifiers and place-of-service codes that vary by payer and service type.

Cross-State Compliance

Different states have varying telehealth regulations, licensure requirements, and reimbursement policies.

Evolving Payer Policies

Telehealth coverage policies constantly change, especially post-pandemic with varying permanent adoptions.

Time-Based Documentation

Proper time tracking and documentation required for virtual E/M services and counseling codes.

Technology Platform Billing

Different telehealth platforms and modalities require specific coding approaches and documentation.

Parity Payment Issues

Not all payers reimburse telehealth at parity with in-person visits, requiring revenue optimization strategies.

Our Solutions

Telehealth Billing Experts

Our team specializes in virtual care billing with up-to-date knowledge of modifier requirements and payer policies.

• Accurate telehealth modifier application
• Real-time payer policy updates
• Synchronous and asynchronous billing expertise
• State-specific compliance management

Compliance & Credentialing

Ensure proper credentialing and compliance across all states where you provide telehealth services.

• Multi-state licensure tracking
• Interstate compact billing support
• HIPAA-compliant telehealth billing
• Platform-specific documentation review

Revenue Maximization

Optimize telehealth reimbursements through proper code selection and payer-specific strategies.

• Maximum allowable billing for virtual services
• RPM and CCM code optimization
• Virtual check-in billing capture
• E-visit and e-consult billing

Platform Integration

Seamless integration with major telehealth platforms and EHR systems for efficient billing workflows.

• Automated claim generation
• Time tracking verification
• Documentation completeness checks
• Real-time eligibility verification

Specialized Services

Synchronous Telehealth

Expert billing for real-time video and audio consultations with proper E/M coding.

• Live video visit billing
• Audio-only services
• E/M level selection
• Telehealth modifier application

Asynchronous Services

Specialized billing for store-and-forward telehealth and e-consults.

• E-visit billing
• Online digital evaluation
• Store-and-forward imaging
• Interprofessional consults

Remote Patient Monitoring

Comprehensive RPM billing including device setup, data collection, and management time.

• RPM setup billing
• Monthly monitoring codes
• Device supply billing
• Time tracking documentation

Chronic Care Management

Complete CCM billing for virtual chronic condition management and care coordination.

• CCM time tracking
• Complex CCM billing
• Principal care management
• Behavioral health integration

Common CPT Codes Reference

Key codes include 70553 (MRI brain with and without contrast), 72148 (MRI spine, lumbar, without contrast), 71250 (CT thorax without contrast), 74177 (CT abdomen and pelvis with contrast), 76700 (Ultrasound abdomen, complete), 76770 (Ultrasound retroperitoneal, complete), 93306 (Echo transthoracic, real-time with image documentation), 71046 (Radiograph, chest, 2 views), 77067 (Screening mammography, bilateral), 78816 (PET/CT scan, skull base to mid-thigh). Proper code selection requires understanding of bundling rules, NCCI edits, and modifier usage.

Expert Billing Insights

Professional vs. Technical Component Billing: Modifier 26 and TC

Radiology billing involves two distinct components for most imaging studies: the professional component (physician interpretation and signed report) and the technical component (equipment, technologist, facility). When a radiologist works in a hospital or owns the equipment, they may bill either globally (both components) or separately with modifiers. Modifier 26 (professional component only) is used when the radiologist interprets images taken on equipment owned by a hospital or another provider. Modifier TC (technical component only) is used when a facility bills for the equipment and technologist without the physician interpretation.

• Global billing (no modifier): radiologist owns equipment AND performs interpretation
• Modifier 26: interpretation only — hospital owns scanner; radiologist bills professional component
• Modifier TC: technical component only — hospital bills for equipment; physician bills separately with 26
• Never bill both TC and 26 for the same service from the same billing entity

Radiology Prior Authorization: Managing the Auth Burden

Prior authorization for advanced imaging (MRI, CT, PET) has become a major burden in radiology billing. Most commercial plans and many Medicare Advantage plans require prior auth for any MRI or CT scan. Authorization management requires tracking each study ordered, confirming approval before scheduling, and documenting the authorization number on the claim. Denied imaging claims due to missing or incorrect prior authorization represent one of the highest-volume denial categories in radiology.

• Establish an authorization tracking system for all advanced imaging orders
• Include auth number in Box 23 of the CMS-1500 claim form
• Denied for missing auth: appeal with documentation that auth was obtained pre-service
• RADMD and AIM Specialty Health are common commercial imaging authorization programs

Interventional Radiology vs. Diagnostic Radiology Coding

Diagnostic and interventional radiology billing require entirely different coding expertise. Diagnostic radiology uses interpretation codes with TC/26 modifier logic. Interventional radiology codes for catheter-based procedures, biopsies, drains, and embolizations are surgical codes with 90-day global periods for some procedures and 0- or 10-day globals for others. When an interventional radiologist performs both the diagnostic study and an intervention in the same session, careful unbundling analysis is required to ensure all separately billable services are captured.

• Diagnostic angiography and interventional procedure on same day: may be separately billable
• IR procedures with 90-day global: no routine post-op billing during global period
• Catheter placement codes are hierarchical — bill the highest-order code only
• Supervision and interpretation (S&I) codes are often bundled with IR procedure codes per NCCI

Payer-Specific Billing Tips

Medicare

• MRI prior auth: required under Medicare Advantage for most advanced imaging
• Lung cancer screening LDCT (G0297): covered annually for risk-eligible beneficiaries
• Mammography: covered annually for women 40+ under Medicare Part B (77067)
• DXA bone density: covered every 24 months for women 65+ and high-risk men

Medicaid

• Medicaid imaging prior auth requirements vary by state and managed Medicaid plan
• Pediatric imaging: EPSDT covers medically necessary imaging — typically without the step therapy
• MRI in pregnant patients: Medicaid typically covers for obstetric and fetal indications
• Managed Medicaid plans often route imaging to in-network radiology centers — verify per plan

Commercial Payers

• Commercial imaging auth programs: RADMD, AIM, EviCore — each has different submission portals
• Stat/urgent imaging: expedited auth pathway; document clinical urgency in auth request
• Out-of-network imaging: subject to balance billing restrictions under NSA for insured patients at in-network facilities
• Medical necessity documentation: include clinical history, prior studies, and physician order in auth request

Appropriate Use Criteria (AUC)

• Medicare AUC: required for advanced imaging orders — physician must consult AUC tool and document result
• AUC compliance: required on claims starting with Applicable Laboratory designation in 2024+
• Document AUC consultation result, GARD number, and clinical decision support mechanism used
• Non-compliance with AUC will result in claim denial — implement at ordering physician level

Related Billing Resources

• Orthopedic Billing
• Oncology Billing
• Cardiology Billing
• Medical Coding Services
• Prior Authorization Services
• CPT Codes Reference Guide
• Medical Billing Modifiers Guide

Key Services

• radiology billing
• diagnostic imaging billing
• MRI billing
• CT scan billing
• X-ray billing
• ultrasound billing