Radiology Billing Services by Prospect Healthcare Solutions
Radiology billing services cover the coding, claims, denials and payments for diagnostic and interventional imaging. Prospect Healthcare Solutions handles prior authorization, professional and technical billing, and follow-up, so your radiologists and imaging staff can focus on accurate reads and patient care.
We support radiology groups and imaging centers across the United States from our office in North Smithfield, Rhode Island. If authorization denials or unpaid scans are slowing your cash flow, start with a free review of your billing.
Prefer to talk? Call +1 (469) 935-4617.
Why Radiology Billing Needs Special Expertise
One imaging study can create two charges: a professional component for the read and a technical component for the equipment and staff. Advanced imaging often needs prior authorization, and the order, the indication and the final report must all agree. If any of them do not match, a claim can be denied after the scan is done.
Radiology Payer Rules We Manage
These are the radiology-specific rules our revenue cycle management team checks on every claim. Rules vary by payer and change often, so we confirm each one against current payer policy.
Professional and technical components
What it means: Modifier 26 reports the interpretation and TC reports the technical service. A global claim covers both when one entity provides both.
How we handle it: We bill the right component for each setting so claims do not overlap with the hospital or another provider.
Prior authorization
What it means: Many plans require authorization for CT, MRI and PET, sometimes through a benefit manager.
How we handle it: We confirm that authorization matches the exact CPT code, including contrast, before the scan.
Orders and medical necessity
What it means: Diagnostic tests generally need an order from the treating provider and a supported diagnosis.
How we handle it: We check the order and report, and code to the highest specificity the report supports.
Contrast coding
What it means: Without, with, and without-and-with contrast are different CPT codes.
How we handle it: We code from the final report and confirm it matches the authorization.
Multiple procedure reductions
What it means: Payers may reduce payment when several imaging studies are done in one session.
How we handle it: We check payment against the fee schedule or contract and appeal underpayments.
Screening versus diagnostic
What it means: Screening and diagnostic mammograms use different codes, and a diagnostic study on the same day may need modifier GG for Medicare.
How we handle it: We review the sequence of services and report them according to payer rules.
Our Complete Radiology Billing Services
We manage the full radiology revenue cycle, from registration and benefit checks to final payment.
1. Eligibility and Authorization Verification
Before the scan we verify coverage, patient costs and authorization, so patients know what to expect and claims are not denied for avoidable reasons. Learn more about insurance eligibility verification.
2. Radiology Coding and Documentation Review
Certified coders assign CPT, HCPCS and ICD-10-CM codes from the final signed report, with components and modifiers checked on every line. See our medical coding services.
3. Clean Claim Submission and Follow-Up
Every claim is checked before submission, then tracked with the payer until it is paid, so nothing is forgotten or left unpaid.
4. Denial Management and Appeals
Every denial is worked through root cause analysis, corrected claims and appeals with supporting records. See our denial management solutions.
5. Payment Posting and Patient Billing
We post and reconcile payments, send clear patient statements, and follow up on balances. Read about our accounts receivable services.
Common Radiology Denials and How We Fix Them
Example: an MRI denied for missing authorization
The denial. A knee MRI is denied with CARC 197 (precertification or authorization absent).
How we fix it: We check whether the authorization exists and matches the code performed. We then correct the claim, or seek retro-authorization or appeal where the payer allows it.
Example: a CT denied for medical necessity
The denial. An abdominal CT is denied with CARC 50 (not deemed a medical necessity).
How we fix it: We review the order, indication and report, correct the diagnosis if the record supports it, and appeal with documentation.
Specialized Radiology Billing Services
Diagnostic Imaging
We bill X-ray, ultrasound, CT and MRI, with contrast, components and authorization checked on every claim.
Breast Imaging
We bill screening and diagnostic mammography, including tomosynthesis and same-day diagnostic follow-up.
Interventional Radiology
We bill guided procedures, with surgical and imaging supervision codes reviewed against bundling rules.
Radiology CPT Codes, HCPCS Codes and Modifiers
These are common radiology codes and modifiers we work with. Examples only: coverage and payment vary by payer, so we confirm each one before billing.
| Description | Billing note | |
|---|---|---|
| 71046 | Chest X-ray, 2 views | Check views documented |
| 70551 | MRI brain without contrast | Authorization often required |
| 70450 | CT head without contrast | Contrast must match report |
| 74177 | CT abdomen and pelvis with contrast | Authorization often required |
| 76700 | Complete abdominal ultrasound | Complete vs limited study |
| 77067 | Screening mammogram, bilateral | Screening diagnosis coding |
| 26 | Professional component | Interpretation only |
| TC | Technical component | Equipment and staff only |
| LT, RT | Left or right side | Required on many studies |
| GG | Screening and diagnostic mammogram same day | Medicare use |
Why Outsource Radiology Billing?
Radiology billing takes specialized knowledge and steady follow-up. Outsourcing to Prospect Healthcare Solutions gives you:
- Lower overhead than a full in-house billing team
- Authorization checks before the scan
- Correct component billing
- Faster follow-up on unpaid claims
- Clear reporting for your owners and managers
Radiology Billing Compliance
We follow HIPAA, CMS and payer rules to reduce your audit risk and build compliance into every step:
- Signed final reports on file
- Orders kept with each claim
- Codes supported by the report
- Modifiers reviewed
- Secure handling of patient information
Who We Serve
Our radiology billing services support:
- Radiology groups
- Independent imaging centers
- Hospital-based radiologists
- Teleradiology practices
- Interventional radiologists
- Mammography centers
We work with providers nationwide, with office support in North Smithfield, Rhode Island. Find your area on our locations page.
Technology and Reporting for Radiology Billing
We use billing analytics to catch problems early and keep you informed:
- Real-time claim tracking
- Denial patterns by payer and code
- Authorization and modality reporting
- Aging accounts receivable reports
- Regular performance reviews
Radiology Billing FAQs
What are radiology billing services?
They cover eligibility checks, prior authorization, coding, claim submission, denial management, payment posting and patient billing for imaging services.
What is the difference between modifier 26 and TC?
Modifier 26 reports the professional read. TC reports the technical service, such as equipment and staff.
Does a CT or MRI need prior authorization?
Often yes. It depends on the plan, so we check each patient and exact CPT code before the scan.
Why are radiology claims denied?
Common reasons include missing authorization, code and contrast mismatches, medical necessity and component errors.
Can you bill for imaging centers and hospital radiologists?
Yes. We bill global and technical claims for imaging centers, and professional claims for radiologists.
How do I get a quote for radiology billing?
Request a free billing quote online or call +1 (469) 935-4617. We review your current billing and send a plan and pricing.
Partner with Experts in Radiology Billing Services
Billing should not distract you from accurate reads and patient care. We handle the coding, claims, denials and compliance so your practice gets paid accurately and on time.