Specialty billing · Radiology

Radiology Billing Services

Every study is two payable pieces. We bill both, correctly.

247 Medical Billing Services has run radiology billing services since 2005, billing the 26/TC split, RBM prior authorization, and the anti-markup rule across Medicare, Medicaid, and every commercial payer for imaging centers, hospital groups, and teleradiology practices. You get a dedicated account manager, a free 360° dashboard, and HIPAA and SOC 2 Type II security, so more of your studies pay on the first submission.

Request a Revenue Review Call +1 888-502-0537
HIPAACompliant SOC 2Type II Serving Since2005 Specialty-FocusedRCM
Component split CT w/ contrast · Live
One study CT abdomen · 70000–79999
26 Professional The radiologist's interpretation and signed report.
TC Technical The scanner, the technologist, and the room.
Component must match the setting
Freestandingglobal Hospital read26 only Teleradiology26 capped
RBM prior auth

Verified pre-exam

number · CPT · date · site
Imaging MPPR modelled, not chased
Anti-markup limit heldDays in A/R < 25
We work with Radiology practices across the U.S. X-Ray CT Scan MRI Ultrasound Mammography
01Two payable pieces per study

How the 26/TC split sets what radiology gets paid

Radiology is the one specialty where nearly every study becomes two payable pieces. Match the component to the actual setting and the claim pays. Miss it, and the study either denies as a duplicate or quietly underpays.

One imaging studyCT · MRI · ultrasound · X-ray
becomes two payable components
Modifier 26

Professional component

Pays the radiologist's interpretation and signed report.

Who billsThe reading radiologist or group
WhereHospital-based reads, billed under the fee schedule
Modifier TC

Technical component

Pays for the scanner, technologist, and room.

Who billsThe equipment owner-operator
WhereThe hospital bills TC under OPPS
Global

Both components

Bills both pieces — but only when a single owner-operator performed each part.

Who billsFreestanding centre or IDTF
RiskDuplicate-component denial if the parts were split

The split is only the first rule. Advanced imaging (CT, MRI, PET, nuclear medicine) has to clear a radiology benefit manager such as Evicore or Carelon before it is performed, and although the ordering physician is supposed to secure that authorization, it is the imaging provider who bills the study and absorbs the denial when the auth is missing. The imaging multiple-procedure payment reduction has to be modelled into expected pay instead of chased as a shortfall, and purchased reads stay capped by the anti-markup rule. We hold all of it before the claim leaves your practice.

The contrast axis — where studies get downcoded
Without contrastIncluding any study where the agent was given orally or rectally only.
With contrastOnly when the agent is given intravascularly, intra-articularly, or intrathecally.
With and withoutA paired non-contrast plus post-contrast series takes one combined code, never two.
Counts as "with"Intravascular · intra-articular · intrathecal
Does notOral or rectal only — code it "without"

Diagnostic imaging

01 / 06
70000–79999

What it covers

X-ray, CT, MRI/MRA, ultrasound, fluoroscopy, DEXA — coded by body area, views, and the without / with / with-and-without contrast axis.

What we manage

Correct modality and contrast code, complete-vs-limited ultrasound, and the 26/TC/global component for the setting.

No rule here forgives a shortcut

None of these rules forgives a shortcut. A modality coded to the wrong body area, a complete ultrasound billed when only a limited study was documented, an IR procedure separated from its supervision-and-interpretation code, a repeat view filed without a 76 or 77 modifier — each one either denies outright or invites a post-payment review that claws the money back later.

Request a revenue review and we'll show you which of these is hitting your remits, or call +1 888-502-0537.

Four shortcuts, one outcome
  • BODY AREAA modality coded to the wrong body area
  • COMPLETEA complete ultrasound billed when only a limited study was documented
  • IR S&IAn IR procedure separated from its supervision-and-interpretation code
  • 76 / 77A repeat view filed without a repeat modifier

Each one either denies outright or invites a post-payment review that claws the money back later. We hold all of it before the claim leaves your practice.

02Risk → exposure → prevention

Where radiology studies quietly lose revenue

Most imaging losses trace back to the same short list of failure points, and each one is easier to close at the front end than to argue after a denial or a recoupment notice. We build the guardrail into the claim before it goes out:

Billing mistake
#1 denial

Advanced study performed without a valid RBM authorization

What it can trigger

Prior-auth denial the radiology group absorbs for the ordering physician's gap

How 247MBS prevents it

We verify the auth (number, CPT/modality, date, site) before the exam and chase it when missing

Billing mistake

Oral/rectal-only contrast coded as "with contrast"

What it can trigger

Downcode, recoupment, or medical-necessity denial

How 247MBS prevents it

We apply the intravascular/intra-articular/intrathecal rule and the with-and-without code correctly

Billing mistake

Global billing when 26 and TC were done by different entities

What it can trigger

Duplicate-component or unbundling denial

How 247MBS prevents it

We bill the correct 26/TC/global component for the actual setting

Billing mistake

Marked-up teleradiology read billed at full fee schedule

What it can trigger

Anti-markup (42 CFR 414.50) overpayment and false-claims exposure

How 247MBS prevents it

We cap purchased reads at the anti-markup limit and confirm reassignment and licensure

Billing mistake

Unbundling the IR procedure from its bundled imaging S&I

What it can trigger

NCCI unbundling denial or modifier-59 misuse recoupment

How 247MBS prevents it

We report the combined IR code and use 59/X{EPSU} only when services are genuinely distinct

Billing mistake

Mammography billed from a non-MQSA-certified facility

What it can trigger

Improper-payment denial — MQSA certification is a condition of payment

How 247MBS prevents it

We confirm current MQSA/FDA certification before any screening or diagnostic mammography claim

Request a revenue review and we'll show you which of these is hitting your remits right now.

03Losses that don't bounce loudly

Outsource radiology billing services

The problem

Imaging is uniquely punishing to bill in-house because the revenue leaks happen in places a general biller never thinks to look.

Where it leaks

A purchased nighthawk read priced above the anti-markup ceiling, a CT sent to the scanner on an authorization the referring office never finished, a "with contrast" code on a study where the contrast was oral. None of these bounce loudly. They surface months later as downcodes, recoupments, and audit letters, long after the exam volume has moved on. A single credentialing lapse or a stale MQSA certificate can freeze a whole line of studies while your equipment keeps depreciating.

The trade

When you outsource radiology billing services to 247MBS, that specialized knowledge stops living in one overworked person's head. Certified coders who work the contrast rule, the component split, and IR bundling every day sit on the same team as the billers filing your claims, RBM authorizations are verified before the exam rather than appealed after the denial, and a transaction-based fee replaces the fixed cost of an in-house department.

The risk removed

When one biller holds all the component, contrast, and authorization knowledge, a resignation or a long absence can stall an entire revenue stream — and hiring a replacement who already understands radiology is slow and expensive. With a specialist team behind you, coverage never depends on one desk.

The payback

Steadier cash, fewer surprises at audit, and a billing operation that scales with your study volume rather than breaking under it. Smaller imaging practices usually gain the most, because they feel every avoidable denial in a single cycle.

Revenue review

Put a dollar figure on what your studies aren't collecting.

A certified imaging specialist reviews your auth-related denials, downgraded contrast studies, and aged A/R — and puts a number on what they are actually costing.

  • 26/TC/global components checked against your settings
  • RBM authorization gaps quantified
  • Purchased reads tested against the anti-markup limit
HIPAA & SOC 2 Type II Back within one business day No long-term lock-in
Request a Revenue Review

Tell us about your practice.

A radiology billing specialist will reach out within one business day.

HIPAA-secure · No obligation · We never share your data

Thanks — we've got it.

A radiology billing specialist will reach out within one business day.

04Scanner to paid, one team

Our radiology billing services

Everything it takes to move an imaging claim from the scanner to paid, run by one certified team instead of split across vendors:

  1. 01Authorize

    Prior authorization & RBM management

    Advanced-imaging authorizations verified before the exam (number, CPT/modality, date range, and site), the ordering-provider gap closed, and medical-necessity denials appealed through peer-to-peer and written appeals.

  2. 02Code

    Radiology coding across every modality

    X-ray, CT, MRI, ultrasound, mammography, nuclear medicine/PET, and interventional procedures coded to the correct CPT, contrast axis, and 26/TC/global component, with IR on the combined code.

  3. 03Submit

    Charge capture & 24-hour clean-claim submission

    The signed report reconciled to the order, the correct component and contrast code applied, scrubbed, and filed within a day.

  4. 04Appeal

    Chase every denied claim to root cause

    Including authorization, medical-necessity, and No Surprises Act QPA disputes with IDR filed inside the deadline.

  5. 05Align

    Certified coders who keep coding and billing aligned

    AAPC/AHIMA specialists handling the contrast rule, complete-vs-limited ultrasound, IR bundling, and modifier accuracy.

  6. 06Accredit

    Enrollment, re-credentialing & accreditation tracking

    Radiologists enrolled, IDTF and advanced-imaging accreditation monitored, and teleradiology reassignment and licensure confirmed so nothing rejects on provider eligibility.

Prefer one accountable owner for the whole cycle? Fold billing, coding, and follow-up into our end-to-end revenue cycle management, or hand off just the pieces you need. Practices splitting reads across sites often pair this hub with our teleradiology billing services for remote and nighthawk work.

05Gaps closed by default

Why imaging groups choose 247MBS

Bringing us on isn't handing your claims to a general biller who happens to accept imaging. It's working with a radiology billing services company that already knows where the money leaks and closes each gap by default:

We win the prior-authorization fight.Evicore · Carelon

Advanced-imaging auths are verified before the study and chased when the ordering physician didn't obtain them, so the number-one radiology denial stops landing on your remits.

We bill the component correctly.26 · TC · global

The 26/TC/global choice is matched to the setting on every study, so hospital reads, freestanding-centre globals, and teleradiology claims all pay instead of denying or double-billing.

We protect you on the anti-markup rule.42 CFR 414.50

Purchased and remote reads are billed within the anti-markup limit, with reassignment and licensure confirmed, so a nighthawk arrangement doesn't become audit exposure.

We actually collect out-of-network.QPA · IDR

Radiology is a protected No Surprises Act ancillary and a high-volume IDR-filing specialty; we review the qualifying payment amount on every out-of-network read and open IDR inside the deadline rather than writing it off.

Numbers that hold month after month

Groups that move to us typically see:

0%
First-pass clean-claim rate
0%
Net collections
up to 0%
Fewer denials
<0
Days in A/R
~0 of 10
Worked denials overturned on appeal
0%
Client-retention rate

Those numbers hold month after month, which is why our client-retention rate sits at 98%, and a named account manager plus a live dashboard mean you see every claim, authorization, denial, and dollar without a long-term lock-in.

06The gap on the remittance

Specialist vs. generalist billing

A generalist learns radiology on your claims. We arrive already fluent in it, and the gap shows up on the remittance:

Capability
General billing company
247MBS
26/TC/global component billingThe component must match the setting.
Limited
Full
RBM prior auth (Evicore/Carelon) & appealsThe number-one radiology denial.
No
Yes
Contrast "with/without/with-and-without" ruleOral-only contrast is not "with".
No
Yes
Interventional radiology combined codesNever the deleted separate S&I.
No
Yes
Imaging MPPR modelled into expected payModelled up front, not chased as a shortfall.
No
Yes
Anti-markup compliance on purchased readsNighthawk arrangements stay compliant.
No
Yes
MQSA & advanced-imaging accreditation trackingCertification is a condition of payment.
No
Yes
No Surprises Act QPA disputes & IDRRadiology is a protected ancillary.
No
Yes
Dedicated account manager & live dashboardEvery claim, authorization and dollar.
Sometimes
Always
07Setting decides the component

Who we serve

The rules shift with the setting, and we bill each one to the detail it demands:

Centres & IDTFs

Freestanding imaging centres & IDTFs

Global and technical billing that has to meet the IDTF performance standards and MIPPA advanced-imaging accreditation as conditions of payment.

What decides the moneyAccreditation held current, global billed only when both parts are yours

Hospital-based

Hospital-based radiology groups

Professional-component (26) reads billed under the fee schedule while the hospital bills TC under OPPS, with the split kept clean across high daily volume.

What decides the moneyA clean 26/TC boundary at volume

Teleradiology

Teleradiology & nighthawk practices

Remote reads billed within the anti-markup rule, with reassignment, out-of-state licensure, and interpreter-of-record integrity confirmed on every claim. See our teleradiology billing services.

What decides the moneyThe anti-markup ceiling on every purchased read

Interventional

Interventional radiologists

Image-guided biopsies, vascular access, angiography, and vertebroplasty billed on the combined procedure-plus-S&I codes.

What decides the moneyThe combined code, never an unbundled S&I

Women's imaging

Mammography & women's imaging

Screening and diagnostic 2D and tomosynthesis billed only from MQSA-certified facilities, with screening-to-diagnostic conversions handled correctly.

What decides the moneyCurrent MQSA certification at the time of service

Physician-owned

Multi-specialty & physician-owned imaging

Where Stark and the in-office ancillary services exception, including the advanced-imaging written-disclosure requirement, sit behind every self-referred study.

What decides the moneyThe written-disclosure requirement met on self-referred studies

08No stall in cash

Switching to 247MBS without a cash-flow gap

Changing billers shouldn't stall your cash, and with us it doesn't.

No new platform

We work inside your existing practice-management and RIS/PACS-linked systems, so nobody relearns a platform.

Checks run in parallel

Credentialing, IDTF and advanced-imaging accreditation review, and teleradiology reassignment checks run in parallel while your claims keep going out the door.

Live in weeks

A named account manager leads the transition from day one, and most radiology practices are fully live within a few weeks.

The denial drop and the faster A/R show up in the first cycles, not a quarter later.

09Built around imaging's decision points

Medical Billing for Radiology

With 247MBS handling medical billing for radiology, more of every study pays on the first submission — because we build the claim around the decision points that quietly cost imaging groups money.

Almost every study splits into two payable pieces before a dollar is collected: the interpretation and the equipment each carry their own component, advanced modalities have to clear a benefit manager before they are performed, and contrast, laterality, and repeat rules all change what a study is worth. Because imaging losses surface quietly as downcodes and recoupments months later, catching each rule up front is exactly what keeps a study fully paid — and it is why our radiology medical billing holds first-pass clean claims near 99%, denials down up to 40%, and days in A/R under 25. Request a revenue review

  • REPORTSigned report reconciled to the orderBefore the claim is built.
  • 26 / TCComponent matched to the settingFreestanding, hospital read, or purchased interpretation.
  • CONTRASTContrast and laterality axes checkedWith, without, or one with-and-without code.
  • AUTHAuthorization verified before the examRather than appealed after the denial.
10A decision framework

Choosing a Radiology Billing Services Provider

The radiology billing services provider you want already knows imaging's component, contrast, and authorization rules — it does not discover them on your remits.

  • Catches the anti-markup breachThe purchased read priced above the ceiling, before it reaches a payer.
  • Catches the wrong global claimWhere interpretation and technical work belonged to different entities.
  • Verifies RBM authorizations before the examNot after the study has already been performed.
  • Applies the with-and-without contrast ruleOne combined code, never two.
  • A named account manager and live dashboardEvery claim, authorization, and denial visible.
  • No long-term lock-inA partner built to protect imaging revenue, not simply process it.

What outsourcing looks like with us

Outsource Radiology Billing — What Outsourcing Looks Like With Us

Outsource radiology billing to 247MBS and the specialized knowledge that protects imaging revenue stops living in one overworked person's head. Coverage never depends on one desk, coding stays current as CPT and RBM policy change each year, and your radiologists read studies instead of settling modifier questions.

You trade the fixed overhead of an in-house department for a transaction-based model that scales with study volume, and smaller practices usually gain the most because they feel every avoidable denial in a single cycle.

See what your studies should really pay or call +1 888-502-0537.

Certified coders sit alongside the billers filing your claims
  • Contrast rule
  • Component split
  • IR bundling
  • RBM auth
  • Anti-markup
  • A/R follow-up
visible end to end
  • MANAGERA named account manager owns the relationship
  • DASHBOARDEvery claim, authorization, denial and dollar in real time
  • MODELTransaction-based, scaling with study volume
We code every study to the component that matches the setting — TC or global for a freestanding center or IDTF, professional-component 26 for a hospital-based read while the hospital bills TC, and the reassigned professional read for teleradiology — so nothing denies as a duplicate or unbundled component.
Yes. Advanced-imaging authorizations are the number-one radiology denial, and we verify the auth number, approved CPT and modality, date range, and site before the exam. When the ordering physician didn't obtain it, we chase it and appeal medical-necessity denials through peer-to-peer and written appeals instead of writing the study off.
We do. Purchased and remote reads are billed within the anti-markup limit — the lowest of the performing supplier's net charge, your actual charge, or the fee schedule amount — with reassignment and out-of-state licensure confirmed so a nighthawk arrangement stays compliant.
Yes. IR services are reported on the combined procedure-plus-imaging-supervision-and-interpretation codes rather than the old separate S&I codes, with catheter placement and image-guidance rules applied so nothing is unbundled or left uncaptured.
We do. AAPC/AHIMA-certified radiology coders and billers work as one team, so the contrast rule, complete-vs-limited ultrasound, IR bundling, and the 26/TC split all stay aligned instead of being split across two vendors.
Usually more so, not less. Smaller practices feel every auth-related denial and every downgraded contrast study, and a transaction-based fee replaces the cost of an in-house biller who has to master radiology's component, contrast, and prior-auth rules alone.

Where we bill

Radiology billing, state by state

Every state pays this specialty differently, and that difference lands on the lines that decide the month. Each state page carries its own programs, authorities and rules — and links on to the 290 city pages beneath it.

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Local pages

290 city pages sit beneath these states, each covering that market's payer mix, the operators we bill for there, and the denials we prevent.

26/TC split·RBM prior auth·anti-markup rule·No Surprises Act

Ready to get more of your imaging claims paid the first time?

Whether you run a freestanding imaging center, a hospital-based group, a teleradiology practice, or an interventional service, our radiology billing services protect every component of every study. Put the 26/TC split, RBM prior authorization, the anti-markup rule, and the No Surprises Act in the hands of a team that treats them as routine — and get the revenue you're leaving on the table back where it belongs.

Request a Revenue Review Call +1 888-502-0537

Prefer email? sales@247medicalbillingservices.com

Request a Revenue Review