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Radiology & Teleradiology Billing Services
Radiology Billing Built for 26/TC Splits, Imaging Authorizations and Cross-State Reads
How Does Radiology Billing Work?
Radiology billing means coding each study from the final signed report, matching it to the authorization the payer approved, and billing the professional component (modifier 26), technical component (TC) or global service to whoever owns each part. For teleradiology it also means billing reads across states and hospitals under the right license and enrollment. Qualigenix does this for imaging providers with coders at 98.9% coding accuracy and an over and undercoding rate under 2%. Book a free billing audit at 786-259-0231.
01
CPT and ICD-10 Selection
CT and MRI codes split by body area and by contrast: without, with, or without followed by with. The diagnosis comes from the final signed report, not the order, and a normal study is coded to the sign or symptom that prompted it.
02
Advanced Imaging Prior Auth
Many health plans send advanced imaging authorization through radiology benefit managers such as eviCore, Carelon Medical Benefits Management and Evolent. When the technologist adds contrast or the radiologist adds a body area, the study no longer matches the authorization, and the claim denies unless the authorization is updated.
03
26, TC and Global Billing
The professional component (26) pays for the interpretation, the technical component (TC) pays for the equipment, staff and supplies, and a global claim pays for both. When a hospital owns the scanner and the group reads, the group bills 26 only. Billing global by mistake is an overpayment.
04
Teleradiology Licensing
A remote read needs a radiologist licensed in the state where the patient was imaged, credentialed at the hospital that ordered the study (often by proxy), and enrolled with the payer under the right billing group. One missing piece turns a finished read into an unpaid claim.
05
Screening Frequency Limits
Medicare pays a screening mammogram once every 12 months and annual low-dose CT lung screening only for patients who meet age and smoking-history criteria, with a shared decision-making visit before the first scan. Studies outside those limits deny unless they're billed as diagnostic with a supporting reason.
06
Orders and Signed Reports
Medicare requires a diagnostic imaging study to be ordered by the treating physician or practitioner. An order that's missing, a report that isn't signed, or a reason for exam that doesn't support medical necessity is the kind of documentation gap behind most radiology improper payments.
07
Common Imaging Denials
Common imaging denials include studies performed outside the authorized code, interventional procedures billed with image guidance the procedure code already includes, and repeat studies sent without modifier 76 or 77.
08
Federal Imaging Rules
Three federal rules carry audit risk for imaging providers. Diagnostic tests need a treating practitioner's order under 42 CFR 410.32. Purchased interpretations fall under the anti-markup limits in 42 CFR 414.50. Mammography claims need the facility's FDA certification under the Mammography Quality Standards Act.
How Qualigenix Closes Each Imaging Revenue Gap
Qualigenix checks each imaging claim against the report, the order and the authorization before it goes out. Each fix below answers one of the problems above, in the same order.
Coding From the Signed Report
Coders assign CPT and ICD-10 codes only from the final signed report, by body area, contrast and findings. Qualigenix holds 98.9% coding accuracy with over- and undercoding under 2%.
Auth Matching
Qualigenix matches each scheduled advanced imaging study to its radiology benefit manager authorization, then rechecks the performed study against it. When the study changes at the scanner, the authorization update is requested before the claim goes out.
26/TC Assignment
Coders assign the professional, technical or global service based on who owns the equipment at each site, so hospital-based reads go out as 26 and freestanding center studies go out global.
Teleradiology Billing
Qualigenix tracks each radiologist's state licenses, hospital privileges and payer enrollments, and bills each read under the group and location the payer has on file.
Screening Eligibility Checks
Staff check screening mammography and LDCT eligibility and the last screening date before the appointment, so patients outside the limits are scheduled as diagnostic studies with the right documentation.
Order and Report Checks
Before billing, Qualigenix confirms each study has a valid order, a signed report and a reason for exam that supports it. Studies with gaps go back to the ordering office or the reading radiologist.
Imaging Denial Appeals
Qualigenix works each imaging denial to its root cause and appeals the ones the documentation supports. Qualigenix overturns 79% of denials across the 50,000 denials it works each month, with an average appeal turnaround under 9 days.
Radiology Compliance Audits
Scheduled audits check order presence, component billing, purchased-interpretation pricing and MQSA certification on mammography claims. Qualigenix holds a 98.6% compliance and audit pass rate.
CASE STUDY 01
How a 3-provider podiatry group cleared $214K in aged A/R
THE SITUATION
A 3-provider podiatry group with roughly 60% Medicare payer mix carried $412,000 in A/R, 38% of it past 120 days. Routine foot care claims (11720, 11721, 11055–11057) had stalled on inconsistent Q7/Q8/Q9 modifiers and class-finding documentation, so payers held or partially paid and nobody worked the remainder. Medicare crossover to secondaries was not being posted, and small patient balances were written off.
WHAT QUALIGENIX DID
We ran a full A/R aging segmentation, worked claims by payer and denial reason rather than by date, rebilled the stalled routine-care claims with corrected modifiers, and reactivated secondary and crossover billing.
Key Outcomes & Turnaround
38% to 14%A/R past 120 days
$214,000recovered from aged A/R
90 daysto turn it around
~60%Medicare payer mix
Audited Practice Results
How a solo podiatrist lifted first-pass acceptance to 96%
THE SITUATION
A solo podiatrist coding 320 encounters a month was stuck at 82% first-pass acceptance. Routine foot care went out without the systemic-condition diagnosis pairing and class findings Medicare requires, so it read as non-covered. Wound debridement was coded to the wrong depth (11042 for skin and subcutaneous where the note supported 11043 for muscle and fascia). Same-day E/M with a procedure went out without modifier 25 and got bundled.
WHAT QUALIGENIX DID
We rebuilt the coding workflow: diagnosis-to-CPT pairing rules for at-risk foot care, correct Q-modifier logic, depth-based debridement coding tied to the operative note, and disciplined use of modifiers 25 and 59/XS.
Key Outcomes & Turnaround
82% to 96%first-pass acceptance
+11%per-encounter reimbursement
60 daysto turn it around
320/moencounters coded
Audited Practice Results
How a 2-location podiatry practice cut its denial rate by two-thirds
THE SITUATION
A 2-location podiatry practice sat at a 19% denial rate, mostly Medicare routine-foot-care and nail-debridement rejections. The denials clustered in three buckets: medical-necessity rejections on routine foot care (missing qualifying diagnosis and class findings), frequency-edit denials on nail debridement billed inside the 60-day window, and missing Q modifiers that flagged services as non-covered.
WHAT QUALIGENIX DID
We built a front-end denial-prevention layer, checking eligibility and coverage against payer LCDs before claims went out, plus a structured appeal workflow with documentation templates mapped to each denial reason.
Key Outcomes & Turnaround
19% to 6%denial rate
$68,000recovered on appealed claims
4 monthsto turn it around
2 locationspractice size
Audited Practice Results
Radiology Coding by Modality and Procedure
Qualigenix codes every imaging modality and image-guided procedure radiology groups bill, under current CPT and Medicare rules.
X-Ray and Fluoroscopy
Plain films and fluoroscopy, coded by body area, number of views and whether contrast was used.
How We Keep Radiology Billing Compliant
Qualigenix keeps radiology billing compliant by billing only studies with a valid order, a signed report and a component split that matches who owns the equipment. Each claim is checked against Medicare's ordering requirement in 42 CFR 410.32, the anti-markup limits on purchased interpretations in 42 CFR 414.50, and the national and local coverage policies for advanced imaging. Mammography claims carry the facility's MQSA certification. Underbilling costs the group revenue it earned, and overbilling invites audits and repayment demands. Qualigenix holds a 98.6% compliance and audit pass rate with an over- and undercoding rate under 2%, and all patient data is handled under HIPAA-compliant security controls.
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Audit Pass Rate
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Variance Threshold
Why Radiology Groups Choose Qualigenix
Imaging claims fail on orders, reports and authorizations, so Qualigenix coders check all three with every code. Medicare's own audit data shows where diagnostic radiology claims go wrong
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Improper Payment Rate
0%
From Doc Gaps
0%
No Documentation
$0M
Paid in Error
Frequently Asked Questions
Qualigenix quotes radiology billing after reviewing your study volume, modality mix, professional and technical split, and current A/R, so the fee reflects the work your group needs. Most groups start with a free billing audit, and the quote follows from it.
Qualigenix bills the professional component with modifier 26 when the group reads but doesn't own the equipment, the technical component with TC when the facility owns it and someone else reads, and a global claim only when one entity does both.
Coders build each interventional claim from the procedure note, bill image guidance separately only when the procedure code doesn't include it, and check NCCI edits before submission.
Yes. Qualigenix works existing imaging A/R by age and payer, starting with claims closest to timely filing limits. Across Qualigenix clients, days in A/R dropped from 54 to 36.
Qualigenix rechecks every performed study against its authorization. When contrast or a body area is added, staff request the authorization update from the payer or radiology benefit manager before the claim goes out.
Yes. Qualigenix tracks each radiologist's state licenses, hospital privileges and payer enrollments, and bills each remote read under the group and location the payer has on file.
Qualigenix works across 133 EMR/EHR platforms, including the RIS, PACS and EHR systems imaging providers commonly use. We confirm your setup on the first call.
Qualigenix onboarding averages 6 days, covering RIS and EHR access, payer enrollment checks, open authorizations and a first coding review. Call 786-259-0231 to schedule a free billing audit and start.