Radiology billing: global, professional and technical components

Imaging codes our team bills most

Modifiers that matter

Payer rules to know

Top denials in radiology billing: global, professional and technical components

What makes radiology billing different from other specialties?

Most imaging is one test with two parts. A machine and a technologist produce the images, and a radiologist reads them and signs a report. Medicare pays those two parts separately, and who may bill each part depends on who owns the equipment, where the patient was, and whether one entity did both jobs.

Four other things sit on top of the split. Many commercial plans require prior authorization for advanced imaging before the scan is done. Several imaging codes carry payment reductions when billed together. Screening and diagnostic mammography follow different coverage rules. And radiologists who read for a hospital are exposed to out-of-network disputes they never see coming, which the No Surprises Act now covers.

What is the difference between global, professional and technical billing?

A global claim reports the code with no modifier and covers both the equipment side and the interpretation. A professional-only claim adds modifier 26 and covers the radiologist's read and report. A technical-only claim adds modifier TC and covers the staff, equipment and supplies.

The Medicare Physician Fee Schedule file tells you which of these are allowed for each code. Its PC/TC indicator of 1 means the code is a diagnostic test with both parts, so modifiers 26 and TC can be used. In the CMS RVU26D release of October 2026, the indicator is 1 for 71046, 74177, 77067 and 73721.

Under the Medicare Claims Processing Manual, chapter 13, section 20.1, the interpretation of a diagnostic procedure includes a written report. The report is part of what the professional component pays for, so tracking report completion belongs in the daily workflow, not in an audit afterward.

Medicare Claims Processing Manual chapter 13, section 150, adds a rule that is easy to miss. Billing globally is only possible when the same physician or supplier entity furnishes both the technical and professional parts, and both are furnished within the same Medicare payment locality. Using the same place-of-service code on both parts does not make a global claim legitimate.

Who bills what when the hospital owns the equipment?

When the patient is a hospital patient, the radiologist group bills the professional component only. Medicare Claims Processing Manual chapter 13, section 20.2.1, says the A/B MAC for professionals may not pay the technical component of radiology services furnished to hospital patients. The hospital is paid for that part as a provider service.

Two exceptions matter. If the patient is neither a hospital inpatient nor an outpatient and is referred from outside into a leased hospital radiology department, section 20.2.3 says both components are payable under the fee schedule to the professional-side MAC. And for a freestanding imaging center or physician office, section 20.2.2 says the technical component is paid under the fee schedule.

Commercial contracts can differ from Medicare on who may bill which component. We read each payer's manual and contract and flag any rule that departs from the Medicare approach. If you want the facility side handled, see hospital and facility billing.

What are the rules for purchased and contracted interpretations?

A group can bill for a read or a technical component it buys from another practice, but the price is capped. This is the anti-markup rule, written in section 1842(n)(1) of the Social Security Act and applied through Medicare Claims Processing Manual chapter 13, section 20.3.

The rule applies when a physician or supplier orders and bills a diagnostic test whose technical or professional part was performed by a physician who does not share a practice with the billing entity. Payment is the lowest of three amounts: the performing physician's net charge to the biller, the biller's actual charge, and the fee schedule amount for where the service was performed.

Three details trip up billing teams. First, the billing entity must identify the performing physician or supplier, including that person's NPI (National Provider Identifier), and the amount charged to the biller. If that information is missing, no payment is allowed. Second, the performing physician must be enrolled in Medicare, though no formal reassignment is needed. Third, section 20.3 states that screening mammography is not subject to the anti-markup limitation.

How do you bill teleradiology reads?

Bill the interpretation with modifier 26 and put the place of service where the patient received the technical component. Medicare Claims Processing Manual chapter 13, section 150, says the place-of-service code for the professional component is the setting in which the beneficiary received the technical component, and the same applies when the read is done from a distant site.

The manual's example is an MRI done on an outpatient hospital campus. The physician furnishes the read from his or her own office. The physician's claim uses POS 22, on-campus outpatient hospital, in item 24B of the CMS-1500 or the matching 837P field.

Payer enrollment for each reading location is a separate task, which we handle through credentialing and enrollment.

Which payment reductions apply to imaging claims?

Four adjustments show up in remittances for imaging, and each one has a different trigger. The file documentation and Claims Processing Manual chapter 13 describe them.

In the October 2026 file, the multiple procedure indicator is 4 for 74177 and 73721, and 0 for 71046 and 77067. So a CT of the abdomen and pelvis billed in the same session as another CT in its family is reduced, while a two-view chest film is not.

How do you bill screening and diagnostic mammography?

Screening mammography is a covered Part B benefit with an age and frequency limit, and Medicare's own manual lists its codes. Chapter 18, section 20, says Medicare covers screening mammography for women, that a prescription or referral is not necessary, and that the Part B deductible is waived.

The age rules in that section are baseline for ages 35 to 39, annual for women over age 39, and no payment under age 35. Annual means 11 full months must have passed after the month of the last screening, counted from the month after the exam.

The code set is CPT 77067 for bilateral screening, 77065 for unilateral diagnostic and 77066 for bilateral diagnostic. Breast tomosynthesis is add-on: CPT 77063 for screening and HCPCS G0279 for diagnostic, each listed separately in addition to the primary procedure. The old HCPCS G-codes for the base exams were used only for dates of service in 2017, and CPT codes applied again from January 1, 2018. See CPT 77067 for the screening code.

A screening claim with no diagnosis code is returned unprocessable when assigned. Report ICD-10-CM Z12.31, encounter for screening mammogram for malignant neoplasm of breast, on the claim; on the professional claim it goes in item 21 with a pointer in item 24E. For institutional claims it is the principal diagnosis if screening is the only service.

When a screening turns diagnostic on the same day, the manual says to bill modifier GG with the diagnostic code, and Medicare will pay both exams. The modifier is for tracking only.

How does prior authorization work for CT, MRI and PET?

On commercial plans, the order is not the end of the process. UnitedHealthcare's outpatient radiology program requires prior authorization for certain advanced imaging, and its public page lists CT scans, MRIs, MRAs, PET scans and nuclear cardiology. The current code list changes, and UnitedHealthcare tells providers to check UHCprovider.com/radiology for the most current list.

Settings matter. UnitedHealthcare's page states that authorization is not required for procedures performed in an emergency room, observation unit or urgent care center, or during an inpatient stay. For its Medicare Advantage and Dual Special Needs plans, it states that prior authorization is not required for a CT, MRI or MRA.

The ordering office carries the duty. UnitedHealthcare's FAQ says the ordering health care professional's office is responsible for notifying the plan before the study is scheduled. If a non-participating ordering professional will not complete the process, the rendering professional must. A rendering practice that skips this faces an administrative claim denial, and the FAQ says you cannot bill members for those denials.

For the imaging group, the practical point is to verify the authorization number on the claim and make sure the ordering office passed it to you. UnitedHealthcare's FAQ says the ordering professional must communicate the authorization number to the rendering professional. Our prior authorization and eligibility verification work covers checking this before the patient is on the table. See also our UnitedHealthcare guide.

Why do imaging claims deny, and what should the documentation show?

The denial table on this page lists five claim adjustment reason codes that radiology teams meet regularly: no authorization, medical necessity, bundling, modifier mismatch and missing information, with the fix for each. Denial management is where those appeals are worked.

Documentation is the quiet cause of all five. For each study we want the order with the clinical indication, the ordering provider's NPI, the authorization number where one is required, the final signed report, and the equipment and location used. The report must be complete because chapter 13 treats the interpretation as including a written report.

Does the No Surprises Act apply to radiologists?

Yes, for out-of-network radiology at in-network facilities. Under 45 CFR 149.420(b), the notice and consent exception cannot be used for ancillary services, and the regulation defines those as items and services related to emergency medicine, anesthesiology, pathology, radiology and neonatology, plus diagnostic services including radiology and laboratory services.

So an out-of-network radiologist reading at a participating hospital must not bill the patient more than in-network cost sharing for a non-emergency study, because the patient cannot waive that protection. Any dispute about the payment amount goes through open negotiation and federal IDR.

How we handle radiology billing

Our team handles radiology billing on the CMS-1500 and the UB-04, including global, 26 and TC claims, mammography, teleradiology and purchased reads. We send claims within 24 hours of charge entry and work denials within 48 hours.

In practice that means we check eligibility and authorization status before the study, match the modifier to the setting and entity, and review the claim against NCCI edits (the National Correct Coding Initiative bundling rules) and payer rules before it goes out. When a plan underpays an out-of-network read, we run the open negotiation and IDR steps from first notice to final payment, and we track the deadlines. We align each EHR, clearinghouse and payer portal workflow with verified team experience, so the work happens in your existing systems. Our AAPC and AHIMA certified coders review coding questions on advanced imaging.

Our method is described on the professional medical billing page. If you want to talk through your radiology volume and payer mix, book a call.