Radiology billing and credentialing turn on one question that most specialties never have to ask, which is who owns the scanner. A single MRI can produce a technical claim from the facility, a professional claim from the radiologist who reads it, or one global claim from a practice that does both, and each version needs a different enrollment behind it. Most of the denials and underpayments we see in imaging start with that setup being wrong, long before anyone looks at a code.
Key Takeaways
- Diagnostic imaging codes split into a technical component (modifier TC) and a professional component (modifier 26), and a claim with neither modifier bills as a global service.
- Medicare cuts the technical payment for each additional CT, MRI, or ultrasound in the same session by 50% and the professional payment by 5%.
- Advanced imaging authorizations cover a specific CPT code, site, and date range, so a protocol change after approval can deny a medically necessary study.
- For 2026, Medicare applies a 2.5% efficiency adjustment to most imaging codes and lowers practice expense payments for many hospital and ASC services.
- Supervising physicians can now meet direct supervision for contrast studies through real-time audio and video, under a permanent 2026 rule.
Technical, Professional, and Global Billing
The technical component pays for the equipment, the technologist, supplies, and the room. The professional component pays for the radiologist’s interpretation and signed report. An imaging center that owns its scanners and employs its own radiologists bills globally, with no modifier. When a hospital owns the scanner, the hospital bills the technical side on its facility claim and the reading group bills modifier 26.
Mixed arrangements cause most of the trouble. A group that reads under contract for an outside imaging center, a practice that leases time on another facility’s MRI, and a hospital-based group that also covers an outpatient site may each need a different claim setup for the same CPT code. Before the first claim goes out, we map who owns each scanner and who is contracted to read for it, so no study ever bills globally from two places at once.
Purchased services add another limit. Medicare’s anti-markup rule caps what a group can collect when it buys a technical component or an interpretation from an outside supplier and bills for it, so those arrangements have to be flagged in the billing system rather than handled claim by claim.
Every diagnostic test on the Medicare fee schedule also carries a required supervision level of general, direct, or personal. If the right level of physician supervision wasn’t in place when the study was performed, the technical component isn’t payable, and that matters most for contrast studies and fluoroscopy.
Modifiers and Payment Reductions
Beyond 26 and TC, imaging claims rely on a short list of modifiers that either change the payment or explain why a study was repeated.
- 26 for the professional component only
- TC for the technical component only
- 50, RT, and LT for bilateral studies and laterality, depending on the code and the payer
- 76 and 77 for a repeat study by the same or a different physician
- 59 or XS for a separate site or session that would otherwise bundle
- FX for X-rays taken on film, which cuts the technical payment by 20%
- FY for X-rays taken with computed radiography, which cuts the technical payment by 10%
- CT for CT scans on equipment that doesn’t meet the NEMA XR-29 dose standard, which cuts the technical payment by 15%
Medicare’s multiple procedure payment reduction applies when one patient has more than one CT, MRI, or ultrasound in the same session. The highest-priced study pays in full, and each additional study loses 50% of its technical payment and 5% of its professional payment. Many commercial plans apply their own version, and if the expected payment loaded for each contract doesn’t reflect it, every underpayment looks correct and nobody appeals.
Imaging in two separate sessions on the same day is billable, but only when the record shows two distinct encounters. Using modifier XS to get past a bundling edit without that documentation is one of the most common audit findings in imaging.
Contrast, Mammography, and Interventional Procedures
Many imaging codes come in three versions, without contrast, with contrast, and without followed by with. CPT treats a study as “with contrast” only when the agent is given intravascularly, intra-articularly, or intrathecally, so oral or rectal contrast alone doesn’t count. In an imaging center or physician office, the contrast agent bills separately under its own HCPCS code, such as Q9965 through Q9967 for low-osmolar iodinated contrast or the A-codes for gadolinium agents, with units based on each code’s dosage descriptor. Under the hospital outpatient payment system, contrast is packaged into the study and doesn’t pay on its own.
Screening mammograms bill as 77067, with 77063 added when digital breast tomosynthesis is performed. Diagnostic mammograms bill as 77065 or 77066. When a screening converts to a diagnostic exam on the same day, both can be billed, and Medicare wants modifier GG on the diagnostic study. A screening claim sent with a diagnostic ICD-10 code loses its preventive status and lands on the patient’s deductible.
Interventional radiology bills more like surgery. Biopsies, drain placements, embolizations, and venous access procedures carry global periods and NCCI edits, and many of those codes already include the imaging guidance. Billing the guidance separately is a common error, and payers know to look for it.
Prior Authorization for Advanced Imaging
Most commercial and Medicare Advantage plans require prior authorization for CT, MRI, PET, and nuclear cardiology, and many send the review to a radiology benefit manager such as eviCore, Carelon, or Evolent. The approval covers one CPT code at one site for a set date range. When the radiologist changes the protocol from “without contrast” to “without and with,” or adds a body area, the claim no longer matches the approval. That’s how an approved authorization can still end in a denied claim, and many benefit managers allow a code update only for a few days after the study.
The ordering physician usually requests the authorization, yet the imaging provider is the one left holding the denial. We check the authorization number, approved code, date span, and rendering site before the patient arrives, and flag protocol changes the same day they happen. Studies that still deny for medical necessity go to our denial management team with the order, report, and clinical history attached.
Traditional Medicare is simpler on this point. CMS ended the Appropriate Use Criteria program for advanced imaging in 2024, so Medicare claims no longer carry AUC consultation modifiers or G-codes.
What Changed for Radiology in 2026
The 2026 Medicare physician fee schedule raised the standard conversion factor to $33.40, but two other changes pull the other way for imaging. A 2.5% efficiency adjustment reduces the work value of most services that aren’t billed by time, which covers nearly every imaging code. CMS also lowered practice expense payments for many services furnished in hospitals and ambulatory surgery centers, a change radiology groups opposed because of its effect on interventional practices. The American College of Radiology estimates the net effect for diagnostic radiology at about a 2% cut.
The same rule made virtual direct supervision permanent. A supervising physician can now be immediately available through real-time audio and video instead of being on site, including for contrast administration, though audio-only doesn’t qualify. For outpatient imaging centers that struggled to keep a physician on site through every contrast shift, that removes a staffing constraint, as long as the supervision is documented.
Quality reporting changed as well. Radiologists now have a diagnostic and interventional radiology MIPS Value Pathway available for the 2026 performance year, which can be simpler than traditional MIPS for groups whose measures already fit it.
Radiology Credentialing
Radiologists
Radiologists certify through the American Board of Radiology or the American Osteopathic Board of Radiology, and many hold subspecialty certificates in areas like neuroradiology or interventional radiology. Payers verify licensure, board status, DEA registration where it applies, malpractice history, and hospital affiliations. For radiologists covering several hospitals, hospital privileging runs on its own timeline next to payer enrollment, and both have to be in place before reads start.
Radiologists who interpret mammograms also have to meet the FDA’s interpreting physician requirements under the Mammography Quality Standards Act. After initial qualification, each one has to read 960 mammograms over every 24 months and earn 15 category I CME credits in mammography every 36 months. Facilities keep that documentation, and we track it next to each radiologist’s payer file.
Teleradiology
A teleradiologist generally needs a license in every state where patients are imaged, and the Interstate Medical Licensure Compact can shorten that process in member states. Medicare doesn’t pay for interpretations performed outside the United States, so overnight reads from abroad are preliminary and a U.S.-based radiologist bills the final. Each group a radiologist reads for needs its own Medicare reassignment through PECOS 2.0, plus separate enrollment with each commercial payer.
Imaging centers and IDTFs
A freestanding imaging center that isn’t part of a physician practice usually enrolls with Medicare as an independent diagnostic testing facility. IDTFs have to meet federal performance standards, name a supervising physician for every test they perform, and document that each technologist holds the required state license or certification. Facilities billing Medicare for the technical component of CT, MRI, nuclear medicine, or PET also need accreditation from a CMS-approved organization such as the American College of Radiology, IAC, The Joint Commission, or RadSite. Mammography sites need their own MQSA certificate.
Most payers recredential every three years, and a lapse stops payment from that payer until it’s restored. A new scanner, a new site, or a new reader all have to be added to the right files before the first study, because you can’t bill what you can’t credential.
Contracting for Imaging Services
Imaging contracts are often written as a percentage of the Medicare fee schedule, and that single number hides a lot. The technical and professional components can be paid at different percentages. Some payers apply their own multiple procedure reductions or pay contrast at a flat rate. Others steer patients from hospital outpatient departments to freestanding centers and price their rates around that shift, which helps an independent imaging center only if its contract reflects the extra volume.
Our payer contracting team reviews each agreement by modality and component, then compares it with what remits are paying. We look at how the contract treats contrast, multiple studies, retro-authorization, and timely filing, and bring that data into renegotiation. Our guide to payer negotiation strategies walks through how those conversations usually go.
Radiology Billing FAQ
Can a radiology group bill globally when a hospital owns the scanner?
No. When the hospital owns the equipment, it bills the technical component on its facility claim, and the reading group bills only the professional component with modifier 26. A global claim from the group in that setting duplicates the hospital’s payment and will be recouped.
What happens when the protocol changes after an imaging authorization is approved?
The claim no longer matches the approved CPT code and can deny even though the study was medically necessary. Many radiology benefit managers allow the authorization to be updated for a few days after the study, so the change has to be reported quickly.
Is contrast billed separately from the imaging study?
In an imaging center or physician office, yes, under its own HCPCS code. In a hospital outpatient department under Medicare, contrast is packaged into the study and isn’t paid separately.
Does Medicare still require Appropriate Use Criteria for advanced imaging?
No. CMS ended the AUC program in 2024, so Medicare claims for CT, MRI, nuclear medicine, and PET no longer need AUC modifiers or consultation codes.
Can contrast studies be supervised virtually?
Yes, under Medicare’s 2026 rule. Direct supervision can be met through real-time audio and video, including for contrast administration, but audio-only contact doesn’t count.
Does Medicare pay for reads by radiologists working overseas?
No. Medicare doesn’t pay for interpretations performed outside the United States. Overnight reads from abroad are treated as preliminary, and a U.S.-based radiologist who is enrolled with Medicare bills the final interpretation.
Medwave for Reading Groups and Imaging Centers
Medwave works with reading groups, independent imaging centers, IDTFs, and teleradiology practices. Some clients send us both components, and some send only the professional side while a hospital bills the technical. Either way, our medical billing team builds the setup around who owns each scanner and holds a 98% clean claim rate on the claims that follow.
For new readers and new sites, our medical credentialing team averages 85 days from application to approval. Teleradiology groups adding states get payer enrollment timed to each new license, so a reader isn’t licensed for weeks before any payer will pay for the reads.
Tell us which modalities you run and which payer is giving you the most trouble.