Radiology billing services for imaging, radiation oncology and lab
One team for every line of radiology revenue: diagnostic imaging, mammography, nuclear medicine, interventional radiology, radiation oncology, and laboratory and pathology. We code it, authorize it, bill it and follow it until it is paid.
Current for 2026 and 2027. Radiation oncology delivery codes, the Medicare lab fee schedule and the 2027 physician fee schedule have all changed. Our claim edits have too.
Illustrative examples. Code selection depends on documentation, setting and payer policy.
Every service line a radiology practice bills
Each line has its own codes, payer rules and ways of losing money. Open one to see where revenue leaks and what we do about it.
Diagnostic imaging
X-ray, ultrasound, CT, MRI, fluoroscopy, bone density
Where revenue leaks
- Global, 26 and TC billed on the wrong basis for the site
- Authorization obtained for one CPT, a different study performed
- Contrast agents and 3D post-processing left off the claim
- Same-session studies sequenced poorly under MPPR
What we do
- Set component and place-of-service rules per site and contract
- Match the authorized CPT to the performed study before billing
- Reconcile contrast and add-ons against technologist and supply records
- Check NCCI edits, laterality and MPPR reductions on the remittance
Mammography and breast imaging
Screening, diagnostic, tomosynthesis, breast ultrasound and MRI, biopsy
Where revenue leaks
- Screening converted to diagnostic on the same day and billed incorrectly
- Tomosynthesis add-on missed, or the wrong add-on used for a diagnostic exam
- Screening frequency limits not checked before the visit
What we do
- Apply screening and diagnostic rules, including same-day conversions
- Pair the correct tomosynthesis add-on with each exam type
- Verify eligibility and frequency before the appointment
- Code image-guided breast biopsies with the right guidance
Nuclear medicine and PET
PET/CT, SPECT, cardiac nuclear, radiopharmaceuticals
Where revenue leaks
- Radiopharmaceutical supply codes missing or billed with the wrong units
- PET denied for coverage or indication under payer policy
- Authorization gaps on the highest-dollar studies in the department
What we do
- Capture the radiopharmaceutical with each study, by dose
- Check coverage indications and diagnosis pairing before the scan
- Run payer and benefit manager authorization end to end
Interventional radiology
Vascular and non-vascular procedures, image guidance, hospital, office lab and ASC
Where revenue leaks
- Catheter placement and bundled imaging guidance coded incorrectly
- Modifiers that do not hold up to NCCI edits
- Site-of-service differences between hospital, office-based lab and ASC missed
What we do
- Code from the full procedure report, not the charge ticket
- Apply bundling rules and modifiers the documentation supports
- Bill each site of service on its own rules
Professional reads and teleradiology
Hospital-based groups, remote reads, multi-site coverage
Where revenue leaks
- Radiologists not enrolled with every payer at every site they read for
- Missing demographics and orders from the facility delay claims
- Location and place-of-service rules for remote reads applied wrongly
What we do
- Keep enrollment, rosters and revalidation current across sites
- Reconcile reads against facility data so nothing goes unbilled
- Bill professional-only claims with modifier 26 on the correct location
Radiation oncology
Simulation, planning, physics, delivery, IGRT, SBRT, brachytherapy, proton
Where revenue leaks
- Charge masters still carrying codes deleted on January 1, 2026
- Commercial contracts paying revised delivery codes at old rates
- Planning, physics or weekly management charges missed across a course
What we do
- Bill the full treatment course against the treatment record
- Apply the 2026 delivery and image guidance code set
- Track payer variances and early denials on the revised codes
Laboratory and pathology
Clinical lab, anatomic pathology, cytology, molecular testing
Where revenue leaks
- Panels unbundled, or components billed alongside the panel
- Medical necessity and frequency denials on common tests
- Molecular tests billed without the identifiers payers require
- Medicare lab fee schedule cuts returning in 2027
What we do
- Apply panel, modifier and date-of-service rules before submission
- Check diagnosis coverage and frequency limits up front
- Split pathology professional and technical components correctly
Request your free radiology revenue audit
Share a few details. We review a sample of your claims and remittances and tell you what we find, by service line.
- Global, 26 and TC billing by site and contract
- Place of service and IDTF enrollment
- Authorized CPT against the study performed
- Contrast, radiopharmaceutical and add-on capture
- Radiation oncology 2026 codes and commercial payer rates
- Lab panels, medical necessity denials and 2027 fee schedule exposure
- Denial patterns, A/R aging and underpayments
Four decisions sit behind every imaging claim
Imaging is a volume business. A small mistake in any one of these repeats across thousands of studies before anyone notices.
Who gets paid for what
Many studies can be billed globally, as a professional read with modifier 26, or as a technical service with modifier TC. The answer depends on who owns the equipment and who reads the study. We set the rule once per site and contract, then check every claim against it.
Where the study was performed
Office, hospital outpatient department and independent diagnostic testing facility each carry their own place-of-service, supervision and enrollment rules. A mismatch turns a correctly performed study into a denied or recouped technical charge.
Whether the payer approved this exact study
Medicare Advantage and commercial plans commonly require prior authorization for MRI, CT, PET and nuclear studies, often through benefit managers such as eviCore and Carelon. We obtain it, then confirm the approved CPT matches what was actually performed.
What was added and what gets reduced
Contrast, tomosynthesis and 3D post-processing are easy to leave off. Additional same-session studies are reduced under the multiple procedure payment reduction. We capture the add-ons and confirm the reductions on the remittance are correct.
Radiation oncology billing follows the treatment course
A course of radiation therapy is not one claim. It runs from consultation through weeks of daily treatment, and each stage bills differently. Two of those stages were rewritten on January 1, 2026.
Full-course charge capture
Planning, simulation, dosimetry, physics, delivery and weekly management reconciled against the treatment record, fraction by fraction.
2026 delivery and image guidance coding
Delivery level assigned from the documented treatment. Deleted codes removed from charge masters and claim edits. Image guidance billed as professional only.
Authorization for complex treatment
IMRT, SBRT, SRS, brachytherapy and proton therapy authorized with the technique, fractions and codes the payer expects. Early 2026 denials on 77412 and 77387-26 tracked and appealed.
Commercial contract review
Many commercial contracts still reference the old code structure. We compare what was paid against what should have been and show you the gap by payer.
What changed on January 1, 2026
| Service | Status |
|---|---|
| External beam delivery, all sites of service | 77402, 77407, 77412 |
| IMRT delivery 77385 and 77386 | Deleted |
| CT guidance 77014 | Deleted |
| Medicare delivery and guidance G-codes | Retired |
| Image guidance, technical component | Bundled into delivery |
| Image guidance, professional component | 77387-26 |
Laboratory and pathology billing, with 2027 cuts in view
Lab claims are low dollar and high volume, so denial rates matter more than anywhere else. And Medicare lab payment is about to drop.
Medicare lab fee schedule cuts are scheduled to return January 1, 2027
Congress held cuts at zero for 2026. New rates built on 2025 private payer data take effect in 2027, with reductions capped at 15% per test per year through 2029. We model the impact by test and tighten denials and underpayments to offset it.
Panels and unbundling
Organ and disease panels billed as the panel when every component is performed, with repeat and reference lab modifiers applied only where they belong.
Medical necessity and frequency
Diagnosis codes checked against national and local coverage policies before the claim goes out, with advance beneficiary notices flagged when a test may not be covered.
Molecular and genetic testing
Proprietary lab analysis codes, test identifiers required under MolDX, and prior authorization for high-cost genetic panels.
Pathology professional and technical split
Surgical pathology, cytology and special stains billed global, 26 or TC according to who prepared the slide and who read it.
Date of service and the 14-day rule
Collection date, hospital stay and who bills Medicare sorted out for specimens collected in a hospital setting.
CLIA and waived testing
CLIA number on every claim, QW modifier on waived tests, and test complexity matched to the certificate the lab holds.
Specimen collection and travel
Venipuncture, collection fees and travel allowances billed when the payer allows them and left off when it does not.
PAMA readiness
Payer payment data kept clean and reportable, so applicable laboratories are ready for the next reporting period.
What changed, and what changes on January 1
The rule changes that should already be in your claim edits, charge masters and payer follow-up.
Medicare paused the Appropriate Use Criteria program
CMS rescinded the AUC regulations. Consultation information no longer belongs on Medicare fee-for-service claims. Medicare Advantage and commercial authorization rules still apply.
Treatment delivery and image guidance codes rewritten
Delivery moved to revised 77402, 77407 and 77412 at every site of service. 77385, 77386 and 77014 were deleted, Medicare G-codes were retired, and image guidance became professional only under 77387-26.
Congress delayed lab fee schedule cuts for one more year
The Consolidated Appropriations Act, 2026 held Medicare lab payment reductions at zero through December 31, 2026 and reset the data used to price tests.
PAMA reporting period
Applicable laboratories reported private payer rates from January through June 2025. CMS used that data to build 2027 rates.
CY 2027 physician fee schedule finalized
The one-time 2.5% conversion factor increase for 2026 expires, lowering base payment rates for 2027. Expected-payment tables need to be rebuilt before January.
CPT 2027, new Medicare rates and lab cuts take effect
The CPT 2027 code set goes live, the 2027 physician fee schedule applies, and Medicare lab reductions of up to 15% per test are scheduled to begin. NCCI edits also update each quarter.
Last reviewed November 2026. General information, not coding or legal advice for a specific claim. Payer rules vary by plan and contract.
The revenue cycle work behind every service line
Take the full revenue cycle or only the parts you need. Each service is run by people who work radiology claims every day.
Prior authorization
Imaging and treatment authorization, portal submission, status follow-up and peer-to-peer scheduling.
Coding and coding audits
CPT, ICD-10-CM and HCPCS coding, modifier review and pre-submission audits.
Charge capture and reconciliation
Completed studies, contrast, supplies and add-ons reconciled against the billing feed.
Claim scrub and submission
NCCI, modifier, laterality and payer-specific edits applied before the claim leaves.
Denial management and A/R
Denials sorted by root cause, appeals filed, and receivables worked by value and deadline.
Payment posting and underpayment review
Remittances posted and compared with contracted rates, with variances followed up by payer.
Credentialing and enrollment
Payer enrollment, revalidation, CAQH and multi-site rosters for radiologists, radiation oncologists and pathologists.
Reporting and analytics
Clean claim rate, denial rate, days in A/R, charge lag and authorization outcomes, each with a written definition.
How a claim moves from order to payment
The same five stages apply to an MRI, a course of radiation therapy and a lab panel. What changes is the rulebook at each stage.
Eligibility and authorization
Coverage verified. Payer or benefit manager authorization obtained for every study, treatment or test that needs it, following that plan's rules.
Coding and charge capture
Each service coded from the documentation on the right component, with contrast, add-ons, supplies and place of service checked.
Scrub and submission
Claims run against NCCI edits, modifier logic and payer-specific rules so errors are fixed before the payer sees them.
Posting, denials and A/R
Payments posted and compared with expected rates. Denials worked by root cause and appealed with documentation.
Reporting and prevention
Monthly review of KPIs and denial patterns, with fixes pushed back upstream so the same denial does not repeat.
Find out where your radiology revenue is leaking
The audit is free and covers imaging, radiation oncology, and lab and pathology.
Radiology billing questions
Something we have not covered? Ask a radiology billing specialist.
Which radiology service lines do you bill for?
Diagnostic imaging (X-ray, ultrasound, CT, MRI), mammography and breast imaging, nuclear medicine and PET, interventional radiology, professional reads and teleradiology, radiation oncology, and laboratory and pathology. You can use us for one line or all of them.
How do you handle the professional and technical component split?
We set billing rules for each site and contract: professional only with modifier 26 for hospital-based reads, technical or global billing where the group or imaging center owns the equipment, and place of service matched to where the service was performed. Every claim is checked against those rules before submission.
Do Medicare claims still need Appropriate Use Criteria (AUC) information?
No. CMS paused the Medicare AUC program and rescinded its regulations effective January 1, 2024, so AUC consultation information should not go on Medicare fee-for-service claims. Medicare Advantage and commercial plans still apply their own authorization rules, often through benefit managers such as eviCore and Carelon, and we follow each plan's requirements.
How do you stop contrast and add-on charges from being missed?
We reconcile completed studies, technologist documentation and supply records against the coded claim. Supported contrast agents and radiopharmaceuticals are billed with the correct HCPCS code and units, and add-ons such as tomosynthesis and 3D post-processing are captured when the documentation supports them.
What changed in radiation oncology coding for 2026?
Since January 1, 2026, external beam treatment delivery is reported with revised CPT codes 77402, 77407 and 77412 at every site of service, and Medicare retired the G-codes it had used. IMRT delivery codes 77385 and 77386 and CT guidance code 77014 were deleted. The technical component of image guidance is bundled into delivery, and the professional component is reported with 77387-26.
Our commercial payers still pay radiation oncology at old rates. Can you help?
Yes. Many commercial contracts still reference the old code structure, so the revised delivery codes can be underpaid. We compare remittances with expected reimbursement, flag variances by payer and code, and give you the data to raise a crosswalk or contract update with each payer.
What is happening to Medicare lab payment in 2027?
Congress held Medicare Clinical Laboratory Fee Schedule cuts at zero for 2026. New rates based on private payer data from the first half of 2025 are scheduled to take effect January 1, 2027, with reductions capped at 15% per test per year through 2029. We model the effect by test and work denials and underpayments harder to offset it.
Do you bill both clinical lab and anatomic pathology?
Yes. We bill clinical laboratory tests, anatomic pathology, cytology and molecular testing, including panel rules, the QW modifier for waived tests, pathology professional and technical components, date-of-service rules and the identifiers payers require for molecular tests.
Can you work in our RIS, EHR or billing system?
Yes. We work inside the practice management, RIS, LIS, oncology information and clearinghouse systems our clients already use, and map charge feeds and remittances during onboarding.
How do you keep coding rules current?
CPT codes change every January, NCCI edits update every quarter and payer policies change through the year. We review each new code set before it takes effect, including CPT 2027 on January 1, 2027, update claim edits each quarter and track payer policy changes for imaging, radiation oncology and lab.