Radiology billing is different from most specialties because one imaging study is usually split into two billable parts: the technical component (equipment, staff, and supplies) and the professional component (the radiologist’s interpretation and report). Who owns the equipment and who reads the study decides which part each entity bills. Get the split wrong and claims get denied, or the same service gets paid twice and has to be paid back.
How Do Professional and Technical Components Work?
- Global billing: one entity owns the equipment and employs the radiologist, so it bills the CPT code with no modifier.
- Professional component only (modifier 26): the radiologist reads a study done on someone else’s equipment, such as a hospital’s.
- Technical component only (modifier TC): the facility or imaging center that did the study bills for it, and the reading is billed separately.
Problems show up when both sides bill globally for the same study, or when a reading group bills globally for studies done at a hospital.
What Is the Multiple Procedure Payment Reduction?
When the same physician, or physicians in the same group, perform more than one advanced imaging study on the same patient in the same session on the same day, Medicare reduces payment. According to Noridian’s guidance, effective January 1, 2017:
- The highest-priced procedure is paid in full.
- The technical component of each additional procedure is paid at 50%.
- The professional component of each additional procedure is paid at 95%.
This applies to codes with a multiple procedure indicator of “4” in the Medicare fee schedule. When you check payments, expect these reductions. Don’t appeal them as underpayments.
What Happened to the AUC Program?
Medicare’s Appropriate Use Criteria program for advanced diagnostic imaging was supposed to require ordering physicians to consult approved criteria and report it on claims. In the CY 2024 Physician Fee Schedule final rule, CMS paused the program and rescinded its regulations, and it hasn’t set a timeline to restart it. Commercial payers are a different story. Many still require prior authorization for MRI, CT, and PET, often through a radiology benefit manager.
Common Radiology Billing Denials
- No prior authorization for advanced imaging, or an authorization that doesn’t match the study performed (for example, approved without contrast, done with contrast).
- Diagnosis doesn’t support medical necessity under the payer’s imaging policy. These often come back as CO-50 denials.
- Component mismatch: global billing where only the professional component applies.
- Bundling edits on studies of contiguous body areas. See our guide to NCCI edits.
- Missing or late reports, since the professional component needs a signed interpretation.
Imaging groups that rely heavily on technical revenue should also watch fee schedule changes closely. Our RVU cuts analysis covers why.
Frequently Asked Questions About Radiology Billing
What does modifier 26 mean in radiology?
Modifier 26 means the claim is for the professional component only: the radiologist’s interpretation and report, not the equipment and staff.
What is the TC modifier?
TC means the technical component only: the equipment, staff, and supplies used to perform the study, billed by the entity that owns the equipment.
How much does Medicare reduce for multiple imaging procedures?
For codes subject to the imaging MPPR, the highest-priced procedure is paid in full, additional technical components at 50%, and additional professional components at 95%.
Is the Medicare AUC program for imaging still in effect?
No. CMS paused the AUC program and rescinded its regulations in the CY 2024 Physician Fee Schedule final rule, with no restart date set.
What OmniBridge Actually Does
We set component billing rules for each site you read for, check MPPR reductions against expected payment, and track imaging authorizations by study, contrast and all.
If your imaging denials keep repeating, request a free practice audit and we’ll show you which rules are causing them.
