Coding, claims, authorizations and AR follow-up for hospital-based radiology groups, freestanding imaging centers, IDTFs and interventional radiology practices.
A brain MRI with and without contrast (70553) is worth $316.97 under the 2026 Medicare fee schedule, but a group reading it for a hospital outpatient department is paid only the $105.21 professional component. Bill it global and the overpayment comes back as a recoupment. Bill it against an authorization for the study without contrast and the whole claim denies. Luxen codes and follows up every imaging claim inside your current RIS and billing system, with certified coders and a BAA signed before access.
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Radiology billing services code, submit and follow up on imaging claims for radiology groups, imaging centers and interventional practices, including global, professional (26) and technical (TC) claims, prior authorizations and denials. The weak point is authorization. Authorization numbers did not match the imaging performed on 7% of advanced imaging claims (Luxen claim audit).
Radiology billing changes with who owns the equipment and where the study is read.
Most radiology revenue loss sits in five claim patterns. Dollar figures are 2026 national Medicare amounts, non-facility, before the OPPS cap and multiple procedure reduction.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Hospital outpatient CT read billed as global | 74177 | The technical component belongs to the hospital, so the global claim is overpaid and later recouped | $216.77 technical component refunded | Coding and modifier errors caused 21% of denials (Luxen claim audit) |
| MRI protocol changed at the scanner | 70551 authorized, 70553 performed | The authorization on file does not match the CPT billed, and the plan denies the claim | $316.97 global for 70553 | Authorization numbers did not match the imaging performed on 7% of advanced imaging claims (Luxen claim audit) |
| Two MRIs in one session, reduction applied to the wrong study | 70553 + 72148 | The payer takes the 50% technical cut from the 70553 TC instead of the lower-priced 72148 TC | $44.26 short | Underpayments against contracted rates appeared on 7.8% of paid claims (Luxen claim audit) |
| Screening mammogram turns diagnostic the same day | 77067 + 77066-GG | The diagnostic line goes out without GG and denies as a duplicate | $156.98 global for 77066 | Duplicate claim denials made up 9% of denials, mostly from resubmitting instead of correcting (Luxen claim audit) |
| Lung screening CT without eligibility on file | 71271, G0296 | No shared decision-making visit or pack-year history, so Medicare denies and the patient disputes the bill | $136.28 global | Eligibility and coverage errors caused 24% of denials (Luxen claim audit) |
Most diagnostic imaging codes split into a professional component (the interpretation, modifier 26) and a technical component (equipment, staff and supplies, modifier TC). A claim with no modifier is a global claim for both.
| Code | Study | Global | 26 | TC |
|---|---|---|---|---|
| 70553 | MRI brain without then with contrast | $316.97 | $105.21 | $211.76 |
| 74177 | CT abdomen and pelvis with contrast | $300.61 | $83.84 | $216.77 |
| 72148 | MRI lumbar spine without contrast | $191.72 | $68.47 | $123.25 |
| 71250 | CT chest without contrast | $132.60 | $49.43 | $83.17 |
| 71271 | Low-dose CT lung cancer screening | $136.28 | $49.43 | $86.84 |
| 77066 | Diagnostic mammography, bilateral | $156.98 | $46.43 | $110.56 |
| 77067 | Screening mammography, bilateral | $126.26 | $35.07 | $91.18 |
| 71046 | Chest x-ray, 2 views | $33.07 | $10.02 | $23.05 |
National amounts at the $33.4009 conversion factor, non-facility, before geographic adjustment.
| Setting | Who bills | Claim |
|---|---|---|
| Office or imaging center that owns the equipment and employs the reader | The practice | Global, no modifier |
| Hospital inpatient or outpatient | Radiologist bills the read; the hospital bills the technical side on its facility claim | Modifier 26 |
| IDTF with an outside radiologist | IDTF bills the test, radiologist bills the read | TC and 26 |
| Practice that buys the read or the test from an outside supplier | The buying practice | Payment capped by the anti-markup rule, 42 CFR 414.50 |
CMS does not pay the technical component under Part B for hospital inpatients, so a global claim for a hospital read is an overpayment. Our medical coding team checks place of service against the modifier on every claim.
Three Medicare rules cut imaging payment before the claim is paid. Each is correct when applied right, and each is a source of short payments when it is not.
When the same physician or group performs more than one imaging study on the same patient in the same session on the same day, Medicare pays the highest-priced technical component in full and the rest at 50%. Since January 1, 2017, the professional component of each additional study is paid at 95%.
| Component | 70553 (paid first) | 72148 | Session total |
|---|---|---|---|
| Technical | $211.76 | $61.63 (50% of $123.25) | $273.39 |
| Professional | $105.21 | $65.05 (95% of $68.47) | $170.26 |
| Total | $316.97 | $126.68 | $443.65 |
Without the reduction the session would pay $508.69, so the correct cut is $65.04.
Under the Deficit Reduction Act of 2005, the technical component of imaging in an office or imaging center is paid at the lower of the fee schedule amount or the hospital outpatient amount. It covers x-ray, ultrasound, nuclear medicine, PET, MRI, CT and fluoroscopy, but not mammography. The multiple procedure reduction is applied first, then the cap.
Payers misapply these rules more often than practices notice. Underpayments against contracted rates appeared on 7.8% of paid claims (Luxen claim audit), and the average underpaid claim was short by $38 (Luxen claim audit). We post each remit against the expected session amount and send short payments to denials and AR recovery.
Screening studies carry no patient cost sharing under Medicare, so a coding slip becomes a patient complaint as well as a denial.
| Code | Service | Medicare patient cost |
|---|---|---|
| 77067 | Screening mammography, bilateral, including CAD | None with assignment |
| 77063 | Screening digital breast tomosynthesis, add-on to 77067 | None with assignment |
| 77065 | Diagnostic mammography, unilateral | Deductible and 20% coinsurance |
| 77066 | Diagnostic mammography, bilateral | Deductible and 20% coinsurance |
| G0279 | Diagnostic digital breast tomosynthesis, add-on | Deductible and 20% coinsurance |
Medicare covers a screening mammogram every 12 months for women 40 and older, plus one baseline between 35 and 39.
When the radiologist sees a finding and performs a diagnostic mammogram on the same day, bill both studies and add modifier GG to the diagnostic code. The patient owes cost sharing on the diagnostic study only.
Medicare covers 71271 with no deductible or coinsurance for patients aged 50 to 77 with no symptoms, at least 20 pack-years of smoking, who smoke now or quit within the last 15 years, with a written order. Before the first scan, the patient needs a shared decision-making visit (G0296).
Updated HRSA Women's Preventive Services Guidelines add the additional imaging and pathology needed to complete breast cancer screening, without cost sharing, for plan years starting in 2026. A follow-up diagnostic study after an abnormal screen should no longer carry cost sharing on non-grandfathered plans. Our patient billing team checks those balances before statements go out.
The rule: the technical component is not paid under Part B for hospital inpatients, and the hospital bills it for outpatients (CMS Claims Processing Manual, Chapter 13). The cost: $216.77 refunded on each 74177 billed global. Luxen audit: Hospital-setting reads went out without modifier 26 on 4% of professional claims, across 8,600 imaging claims (Luxen claim audit).
The rule: the full technical component goes to the highest-priced study and 50% to the rest (CMS Transmittal 3578). The cost: $44.26 when the cut lands on 70553 instead of 72148. Luxen audit: Paid multi-study imaging sessions came in below the MPPR-adjusted amount on 6% of sessions (Luxen claim audit).
The rule: bill both and add GG to the diagnostic code (CMS Transmittal 3844). The cost: $156.98 for 77066. Luxen audit: Duplicate claim denials made up 9% of denials, mostly from resubmitting instead of correcting (Luxen claim audit).
The rule: NCD 210.14 requires ages 50 to 77, 20 pack-years, quitting within 15 years and a shared decision-making visit first (CMS NCD 210.14). The cost: $136.28 per denied 71271. Luxen audit: Eligibility and coverage errors caused 24% of denials (Luxen claim audit).
The rule: CMS paused the AUC program and rescinded its regulation in the 2024 fee schedule (CMS AUC program page). The cost: scrubber edits built for old rules that hold clean claims. Luxen audit: Coding and modifier errors caused 21% of denials (Luxen claim audit).
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
We bill inside the systems your radiology practice already runs, with no migration.
38% had changed EHR or practice management system in the past five years, and of those, 71% said collections dipped for at least six months after the switch (Luxen Practice Manager Survey 2026). We sign the BAA first and work from the orders, reports and schedules you already keep.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Radiology findings from the Luxen claim audit (61,400 claims audited, Jan 2025 to Jun 2026) and Luxen billing reviews (410 practice billing reviews, Jan 2025 to Jun 2026):
Global, professional, and technical components were not consistently assigned to the correct entity. Luxen corrected the workflow, recovered $143,800, and reduced component-related rejections by 74%.
Revenue Cycle Director, diagnostic imaging group
Imaging claims were leaving without the diagnosis and authorization information from the referring order. Luxen added a pre-bill match, reducing medical-necessity and authorization denials from 18% to 5%.
Practice Administrator, multi-location radiology center
Full engagements are written up in our dental practice case study and our ambulance billing case study.
Since January 1, 2026, Medicare Advantage, Medicaid and CHIP plans must decide expedited requests within 72 hours and standard requests within 7 calendar days, with a specific reason for any denial. Missing or invalid prior authorization caused 17% of denials (Luxen claim audit). Our eligibility and prior authorization team matches the approved CPT to the study performed before the claim is sent.
Radiology is an ancillary service under 45 CFR 149.420, so an out-of-network radiologist at an in-network facility cannot use notice and consent to balance bill. State-regulated plans can follow state processes instead, such as arbitration in Texas under SB 1264 or Illinois rules under 215 ILCS 5/356z.3a.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, set by study volume, the mix of professional and global claims, interventional work and authorization load. No setup or exit fee.
| Service line | Monthly collections | Luxen at 3% | Luxen at 6% |
|---|---|---|---|
| Hospital professional reads (26) | $85,000 | $2,550 | $5,100 |
| Imaging center global and technical claims | $50,000 | $1,500 | $3,000 |
| Interventional radiology procedures | $15,000 | $450 | $900 |
| Total | $150,000 | $4,500 | $9,000 |
| Cost | In-house | Luxen |
|---|---|---|
| Monthly | $11,850 (7.9% of collections) | $4,500 to $9,000 |
| Annual | $142,200 | $54,000 to $108,000 |
| When a biller leaves | Open biller roles took a median 67 days to fill | Coverage continues |
| Terms | Salaries, benefits, software and coding education | Month to month, 30 days notice |
Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews). This example group collects $1.8M a year.
| Partner type | Component and authorization checks | IR and mammography | Reporting | Terms |
|---|---|---|---|---|
| In-house biller | Depends on one person | Often learned on denials | Built by your team | Payroll and turnover |
| Generalist billing company | Usually after a denial | Often professional claims only | Standard aging | Often annual |
| Specialty radiology billing company | Usually built in | Varies by vendor | Varies | Varies |
| EHR or RIS vendor RCM | Software edits | Limited outside the platform | Inside the platform | Tied to the software contract |
| Luxen | Pre-bill check on every imaging claim | Included | Monthly denials and AR by modality, payer and component | Month to month, 30 days notice |
Compare medical billing companies, or see what full-service medical billing includes.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
Most imaging codes split into a professional component (modifier 26) and a technical component (TC), and who bills each depends on the setting. Medicare then reduces the technical component of additional studies in the same session by 50% and the professional component by 5%, and caps office technical payments at the hospital outpatient rate. Many commercial and Medicare Advantage plans also require prior authorization for CT, MRI and PET.
Luxen charges 3% to 6% of collections, with no setup or exit fee. A group collecting $150,000 a month would pay $4,500 to $9,000, against about $11,850 a month for a fully loaded in-house billing team. The rate depends on the mix of professional reads, global claims and interventional work.
Plan on about 2 weeks from a signed BAA to working claims. Median time from signed BAA to first claims worked was 9 business days (Luxen client data), and first recovered payments usually arrive in about 3 weeks. We work the oldest AR and open authorization denials first, and the contract is month to month with 30 days notice.
Yes. We work inside Epic Radiant, Sectra, Fujifilm Synapse, Intelerad and other RIS platforms, plus the practice management system your claims leave from, so nothing is migrated. For hospital reads we reconcile the hospital schedule against signed reports so every professional claim is captured.
Bill the screening code 77067 and the diagnostic code, such as 77066, on the same claim, and add modifier GG to the diagnostic line. Medicare waives cost sharing on the screening study, and the patient owes the deductible and 20% coinsurance on the diagnostic study only.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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