a missed radiology-benefit-manager authorization on MRI, CT, or PET is the largest single uncollectible.
Radiology billing · Massachusetts
Radiology Billing Services in Massachusetts
Radiology billing services in Massachusetts run through a payer structure the rest of the country doesn't share: MassHealth delivered through accountable care organizations (ACOs) anchored to the state's own health systems, layered over managed-care plans and a fee-for-service PCC option. 247 Medical Billing Services keeps the professional-technical split, the prior-authorization queue, and the ACO-routing logic aligned to that model so your interpretations pay the first time — whether you read for an academic system in Boston or run a freestanding imaging center in Worcester. You get a dedicated account manager, a free performance dashboard, HIPAA and SOC 2 Type II compliance, and a radiology billing company that has worked imaging claims since 2005.
HIPAACompliant
SOC 2Type II
Serving Since2005
Specialty-FocusedRCM
We bill Radiology across Massachusetts
Diagnostic Imaging
CT & MRI
Ultrasound
Interventional
Mammography
And More
Best Radiology Billing Services in Massachusetts (MA)
Massachusetts's defining radiology challenge is its accountable-care architecture. MassHealth, run by the Executive Office of Health and Human Services (EOHHS), delivers most members through ACOs — Mass General Brigham, Tufts Health Together, WellSense, Fallon, Be Healthy Partnership, and Boston Children's among them — plus a Primary Care Clinician (PCC) plan on fee-for-service. Each ACO is tied to a provider network and carries its own prior-authorization pathway and radiology-benefit-manager edits for MRI, CT, and PET. A study read for an ACO member has to be routed to that ACO's rules, and a claim built for the wrong network denies before anyone reads the remittance.
Over the MassHealth layer sits traditional Medicare and its Massachusetts Part B MAC, National Government Services (Jurisdiction JK), whose Local Coverage Determinations govern medical necessity for advanced imaging. A Massachusetts radiology claim pays cleanly only when it is routed to the correct ACO, MCO, or Medicare MAC, coded to that payer's current rules, and cleared through prior authorization on the right clock — MassHealth's authorization-from-prescription timing and invoice-source rules are strict enough to sink claims that are otherwise clean. Keeping the professional read, the technical component, and the ACO routing aligned is work a generalist billing services company is not built to do.
Massachusetts radiology billing at a glance
| Facet | Massachusetts detail |
|---|---|
| Medicaid program | MassHealth / EOHHS |
| Delivery model | ACO/MCO plus PCC plan (FFS) |
| Major ACOs/MCOs | Tufts Health Together, WellSense, Mass General Brigham, Fallon, Be Healthy, Boston Children's |
| Medicare Part B MAC | National Government Services (Jurisdiction JK) |
| Appeal window | 30 days (Board of Hearings; varies) |
| Medicaid enrollment | ~1.55 million |
| Key billing challenge | ACO routing plus strict PA and invoice-source timing |
Radiology Billing Services in Massachusetts for Every Practice
Massachusetts imaging operations vary widely, and the professional-technical split follows the ownership. A reading group interpreting on a hospital's scanner bills the professional component under modifier 26 while the facility bills the technical component (TC); a freestanding center that owns both scanner and read bills globally. In a state built around large academic systems in Boston and Cambridge, community hospitals across Worcester and Springfield, freestanding imaging centers, and multi-specialty groups running in-office ultrasound and CT, those arrangements sit side by side — and billing a professional read globally or duplicating a technical charge invites denials and recoupments alike. The concentration of teaching hospitals also means a high share of subspecialty reads — neuroradiology, musculoskeletal, and body imaging — where the interpretation is billed by a group on facility equipment and the technical component belongs to the hospital, a split that has to be coded correctly on every study or the professional revenue leaks.
Advanced-imaging prior authorization is the daily discipline. Most MRI, CT, and PET studies in Massachusetts require radiology-benefit-manager authorization before the scan, and the ACOs and MCOs do not share one portal. Our team clears that authorization as a production step inside the correct network, confirms contrast and physician-supervision requirements before submission, and applies repeat-study modifiers 76 and 77 when an interpretation is re-read — using modifier 59 only where the NCCI edits truly support unbundling. With a 30-day Board of Hearings appeal window, catching these issues before submission matters, which is a large part of why practices outsource radiology billing here.
How radiology claims get paid in Massachusetts
Codes appear only to show the mechanics our team runs on every Massachusetts study.
| Study or element | How it's billed | What drives payment |
|---|---|---|
| MRI brain w/wo contrast (70553) | Prior auth, then 26 / TC or global | RBM authorization before the scan |
| CT abdomen and pelvis (74177) | Global, or split by ownership | Who owns scanner vs read; site of service |
| PET imaging (78815) | Advanced imaging, LCD-governed | Medical necessity per NGS Jurisdiction JK LCD |
| Read on facility equipment (74177-26) | Professional component, modifier 26 | Group reads; facility bills the technical component |
| Screening mammography (77067) | Global or technical | Frequency and screening-vs-diagnostic intent |
| Repeat interpretation | Modifiers 76 / 77 | Same- or different-physician re-read documented |
| Contrast / bilateral studies | Modifiers RT / LT / 50; supervision | Laterality and contrast-supervision met |
Where Massachusetts radiology practices lose revenue
a claim built for a network the member isn't attributed to denies for eligibility.
MassHealth's authorization and documentation clocks reject otherwise-clean claims.
a professional read billed globally, or a technical charge duplicated.
the ordering diagnosis fails the NGS Jurisdiction JK coverage determination.
components billed in rejected combinations, or a re-read submitted without modifier 76 or 77.
Revenue review
Put a dollar figure on what your radiology claims are leaving behind.
A certified radiology billing specialist reviews your coding, unit counts, authorizations and aged A/R against the payers you actually bill in Massachusetts — and puts a number on what your current process is leaving on the table.
- Professional and technical components billed to the right entity per site
- Advanced-imaging authorization confirmed before the study is read
- Contrast, laterality and comparison-study modifiers checked per payer
HIPAA & SOC 2
Back to you within one business day
No long-term lock-in
Request a Revenue Review
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Why Massachusetts practices outsource radiology billing to 247MBS
An ACO-driven state with strict authorization timing is exactly where a radiology-fluent partner earns its keep. When you outsource to 247MBS, the ACO-routing decision, the prior-auth queue, the 26/TC split, the invoice-source documentation, and the LCD check are all resolved before submission — not after the denials arrive. We run eligibility and payer verification to pin the correct ACO, MCO, or Medicare MAC per patient, denial management and appeals filed inside the 30-day Board of Hearings window, and A/R follow-up that chases aged imaging balances to resolution. Our compliant results — a 99% clean-claim rate, roughly 99% net collections, A/R under 25 days, up to 40% fewer denials, and 90% of denials recovered — are measured against your own book in the audit. It all runs inside our radiology revenue cycle practice, one team and one dashboard, backed by 98% client retention. Groups wanting the wider view can see our Massachusetts medical billing overview for how the same discipline applies across specialties.
Who we serve in Massachusetts
We bill the full range of Massachusetts imaging: independent radiology reading groups, freestanding imaging and diagnostic centers, hospital-affiliated and health-system outpatient radiology, teleradiology practices reading across state lines, and multi-specialty groups running in-office X-ray, ultrasound, and CT. From Boston and Cambridge to Worcester, Springfield, and Lowell, our medical billing services company handles the entire MassHealth, ACO, Medicare, and commercial cycle. For teleradiology reads, we confirm the reading radiologist's Massachusetts licensure and payer enrollment before the first claim, and for cross-border groups reading into neighboring New England states we verify enrollment in each state's plans as well.
Medical Billing for Radiology in Massachusetts
Medical billing for radiology in Massachusetts lives or dies on ACO routing, and 247MBS builds that decision into the queue so interpretations pay the first time. We collect for the academic subspecialty groups reading on Boston and Cambridge hospital equipment, the community centers across Worcester and Springfield, and the teleradiology panels covering New England — splitting each professional read from the technical component and routing every claim to the member's attributed MassHealth ACO before it goes out. We clear radiology-benefit-manager authorization on MassHealth's strict clock and code each Medicare read to the NGS Jurisdiction JK policy. Our imaging clients hold a 99% clean-claim rate with days in A/R under 25. Request a revenue review and watch the misroutes stop.
Choosing a Radiology Billing Services Provider in Massachusetts
FAQ
Members are attributed to an ACO tied to a specific provider network, so the study has to be routed and authorized under that ACO's rules — not MassHealth generically. We verify the member's ACO first, then build the claim to that network's prior-authorization and coverage edits.
MassHealth through its ACOs and MCOs — Mass General Brigham, Tufts Health Together, WellSense, Fallon, Be Healthy Partnership, and Boston Children's among them — plus the PCC fee-for-service option, traditional Medicare and its MAC, National Government Services, and your commercial carriers.
MassHealth enforces strict windows on when prior authorization must be obtained relative to the order and on the documentation that must back a claim. We treat both as pre-submission checkpoints so studies don't deny on timing after the read is done.
Yes — we confirm the reading radiologist's multi-state licensure and payer enrollment and apply repeat-read modifiers 76 and 77 when a study is re-read.
26 / TC split·place of service·prior authorization·laterality
Ready to get more Massachusetts claims paid on the first pass?
Whether you are a solo practice or a multi-site group, we bill Radiology across Massachusetts under one dedicated account manager and a live dashboard — and treat every counted unit, authorization and appeal as recoverable revenue until it is safely paid.
Prefer email? sales@247medicalbillingservices.com