Radiology billing can be complex due to the various roles and rules involved, particularly when it comes to distinguishing between the ‘ordering physician’ and the ‘rendering physician.’ These terms, while frequently used, are often misunderstood, leading to billing errors and missed reimbursements.
This blog will clarify the differences between ordering and rendering physicians in radiology billing, highlight common challenges, and provide best practices to ensure accurate and timely reimbursement.
Defining the Roles: Ordering Physician vs. Rendering Physician
Understanding the distinct roles of the ordering and rendering physicians is crucial for accurate billing and reimbursement in radiology services.
Ordering Physician
These two points will help you understand the role of the ordering physician:
- Initiates the Service: The ordering physician, usually a primary care provider or specialist, requests specific radiology tests or procedures, such as an X-ray, MRI, or CT scan, based on the patient’s needs.
- Does Not Perform the Procedure: The ordering physician assesses the patient’s needs and refers them to a radiology facility or department for further imaging. They do not usually conduct or supervise the imaging procedure.
Rendering Physician
These two points will help you understand the role of the rendering physician:
- Performs the Service: The rendering physician, often a radiologist, oversees or directly conducts the radiology procedure. This includes ensuring the procedure is carried out safely and effectively, either by them or by radiology technologists under their supervision.
- Interprets Results: After the test, the rendering physician analyzes the images and provides a detailed report with findings that the ordering physician can use for diagnosis and treatment planning.
Key Points to Remember in Radiology Billing
Radiology billing requires understanding both technical and professional components, specific payer rules, and documentation requirements to ensure accurate reimbursement.
1. Separate Billing for Ordering and Rendering Physicians
While both the ordering and rendering physicians contribute to patient care, they each bill for their specific roles. Billing depends on clearly documenting each provider’s role and responsibilities to meet payer requirements.
2. The Technical & Professional Components of Radiology Billing
Radiology billing is often split into two components:
- Technical Component (TC): This covers costs associated with the facility, imaging equipment, and any personnel involved in carrying out the procedure. It’s usually billed by the facility where the test is conducted.
- Professional Component (PC): This refers to the rendering physician’s interpretation of the imaging results and their written report. Only the physician responsible for the interpretation can bill for this component.
Radiologists must apply specific modifiers to differentiate between the technical and professional components of their services. Depending on how the procedure is billed, a radiology service may be assigned different codes.
To distinguish these components, the following CPT code modifiers are typically used:
- TC Modifier: For billing the technical component only.
- 26 Modifier: For billing the professional component only.
For example, CPT code 76700 is used for an abdominal ultrasound. If a radiologist performs this ultrasound in their own office, they would use CPT code 76700 with a “-26” modifier to bill for the professional component. This covers the interpretation and report of the scan, not the actual procedure itself.
If the ultrasound is done at a hospital or imaging center, the facility would use CPT code 76700 with a “-TC” modifier. The “-TC” modifier shows that the facility is billing only for conducting the procedure, not for interpreting the results.
It’s important to remember that the reimbursement amount may differ depending on who bills for each part. Insurance companies and other payers often have different reimbursement rates based on the provider and setting.
Here’s the table for CPT codes used in radiology billing:
CPT Code Range for Radiology Billing
| Service/Procedure | CPT Code | Component |
| X-Ray | 71010 – 71045 | Technical/Professional |
| Chest X-ray, single view | 71045 | Technical |
| Chest X-ray, 2 views | 71046 | Technical |
| Chest X-ray, 3 or more views | 71047 | Technical |
| MRI (Magnetic Resonance Imaging) | 70551 – 70553 | Technical/Professional |
| Brain MRI without contrast | 70551 | Technical |
| Brain MRI with contrast | 70552 | Technical |
| Brain MRI with and without contrast | 70553 | Technical |
| CT Scan (Computed Tomography) | 70450 – 70496 | Technical/Professional |
| Head CT scan without contrast | 70450 | Technical |
| Head CT scan with contrast | 70460 | Technical |
| Abdominal CT scan with contrast | 74160 | Technical |
| Ultrasound | 76700 – 76705 | Technical/Professional |
| Abdominal ultrasound | 76700 | Technical |
| Pelvic ultrasound | 76856 | Technical |
| Obstetric ultrasound | 76801 | Technical |
| Mammography | 77065 – 77067 | Technical/Professional |
| Screening mammography, 2 views | 77067 | Technical |
| Diagnostic mammography, 2 views | 77066 | Technical |
| Fluoroscopy | 76000 – 76080 | Technical/Professional |
| Fluoroscopy, for gastrointestinal exam | 74246 | Technical |
| Fluoroscopy, for barium enema | 74270 | Technical |
| Bone Density Scan (DEXA) | 77080 – 77083 | Technical/Professional |
| Dual-energy X-ray absorptiometry (DEXA) | 77080 | Technical |
| Nuclear Medicine | 78012 – 78306 | Technical/Professional |
| Bone scan with imaging | 78306 | Technical |
| Thyroid scan with uptake | 78012 | Technical |
| Interventional Radiology | 36556 – 36569 | Technical/Professional |
| Placement of dialysis catheter | 36556 | Technical |
| Biopsy of liver, needle | 47000 | Technical |
Keynote:
Some codes may be billed under both components depending on the specific service provided.
3. Payer Rules and Regulations
Payers, including private insurers and government programs like Medicare and Medicaid, each have their own requirements for radiology billing, including documentation, coding, and pre-authorization. Each component must be coded and documented accurately to avoid claim denials.
New and Revised CPT Codes for Radiology Billing in 2025
The American College of Radiology (ACR) has announced that starting January 1, 2025, several new and updated Category I codes will be introduced.
| Category | CPT Code | Description |
| MR Safety Procedures | 7XX00 | Initial 15-minute assessment of MR safety for implants/foreign bodies by trained staff, including identification, verification, and consultation with professional guidelines, with a written report. |
| 7XX01 | Additional 30-minute MR safety assessment for implants/foreign bodies (listed separately from the primary procedure). | |
| 7XX02 | Physician-led MR safety determination, including risk-benefit analysis and MR equipment assessment, with a written report. | |
| 7XX03 | MR safety customization and performance monitoring by a medical physicist, including sequence planning and risk reduction, with a written report. | |
| 7XX04 | Implant electronics preparation under supervision, ensuring device integrity and patient safety in MR settings, with a written report. | |
| 7XX05 | Implant positioning and immobilization to prevent MR-induced risks, performed under supervision, with a written report. | |
| MRI-Monitored Transurethral Ultrasound Ablation (TULSA) | 5X006 | Placement of transurethral ablation transducers, including suprapubic tube and endorectal cooling device if performed. |
| 5X007 | Prostate tissue ablation using transurethral thermal ultrasound, guided and monitored via MRI. | |
| 5X008 | Comprehensive prostate ablation with transducer placement, suprapubic tube, and cooling device, if performed. | |
| MRI-Guided High-Intensity Focused Ultrasound (MRgFUS) | 0398T | Conversion of MRgFUS from Category III to Category I, with new codes created for planning, insertion, and ablation. |
| Transcranial Doppler Studies | 93893 | Revised code for emboli detection with intravenous microbubble injection. |
| 93890 | Deleted code for vasoreactivity study. | |
| Percutaneous RF Ablation of Thyroid | New Code | A new code for percutaneous radiofrequency ablation of thyroid, plus an add-on code for additional nodules. |
| Fascial Plane Blocks (FPB) | 64486 | A new code for percutaneous radiofrequency ablation of thyroid, plus an add-on code for additional nodules. |
| Fascial Plane Blocks (FPB) | 64486 | Unilateral transversus abdominis plane (TAP) block by injection, including imaging guidance. |
| 64487 | Unilateral TAP block by continuous infusion, including imaging guidance. | |
| 64488 | Bilateral TAP block by injection, including imaging guidance. | |
| 64489 | Bilateral TAP block by continuous infusion, including imaging guidance. | |
| CT Colonography Screening | – | CT colonography (CTC) screening for colorectal cancer is included in the 2025 Medicare Physician Fee Schedule Proposed Rule. |
| Vascular Procedures | 75774 | Revised to clarify reporting for arteries and veins; cross-references to codes 75600-75756 and 36215-36248 deleted. |
| Deleted CPT Codes (2025) | 0398T | MRgFUS stereotactic ablation lesion for movement disorders. |
| 93890 | Transcranial Doppler vasoreactivity study. | |
| 99441 | Telephone E/M service for 5-10 minutes of medical discussion. | |
| 99442 | Telephone E/M service for 11-20 minutes of medical discussion. | |
| 99443 | Telephone E/M service for 21-30 minutes of medical discussion. | |
| Extended Category III Codes (until Dec 2030) | 0071T | Focused ultrasound ablation of uterine leiomyomata (<200 cc), including MR guidance. |
| 0072T | Focused ultrasound ablation of uterine leiomyomata (≥200 cc), including MR guidance. | |
| 0075T | Transcatheter vertebral artery stent placement (initial vessel), with radiologic supervision. | |
| +0076T | Additional vertebral artery stent placement (listed separately). | |
| 0200T | Unilateral percutaneous sacral augmentation (sacroplasty), including imaging guidance and biopsy. | |
| 0201T | Bilateral percutaneous sacral augmentation (sacroplasty), including imaging guidance and biopsy. | |
| 0554T | Bone strength/fracture risk assessment using finite element analysis with CT scan data, including interpretation and report. | |
| 0555T | Bone strength/fracture risk assessment, including data retrieval and transmission. |
Common Challenges in Radiology Billing and How to Address Them
Even with a solid understanding of billing components, radiology practices often encounter challenges. Here’s a look at some frequent issues and solutions to overcome them.
- Incorrect Coding
Upcoding and undercoding can result in incorrect reimbursements, financial losses, and potential legal issues for healthcare providers. Let’s study how:
- Undercoding
Radiology billing often faces issues like undercoding, where a service is billed at a lower level than what was actually done or documented. This can lead to lower reimbursement rates, causing radiology providers to miss out on revenue they deserve.
For example, if a patient receives a CT scan of the pelvis and abdomen with contrast, it should be billed using CPT code 74183. However, if the radiology center mistakenly bills for a non-contrast CT scan (CPT code 74177), which provides less detailed imaging, this results in undercoding. In this case, the provider loses out on payment for both the contrast material and the enhanced imaging, even though these are important for the patient’s care.
- Upcoding
Upcoding is the opposite issue. It happens when billing is done at a higher level than the service actually provided, leading to inflated reimbursements. If done intentionally, it’s considered fraud.
For instance, if a radiologist performs a limited ultrasound (CPT code 76775), which is a quick scan to check for specific issues, billing for a more detailed ultrasound like a full abdominal (CPT code 76700) or pelvic ultrasound (CPT code 76856) would be upcoding. These codes are for more thorough exams that go beyond what a limited scan provides.
Upcoding is against medical billing rules and can lead to fines, legal trouble, and damage to a provider’s reputation. Radiology billing professionals need to document and code services accurately to ensure that claims are submitted ethically and correctly.
| Pro Tip: Keep your knowledge of CPT and ICD-10 coding up-to-date on a regular basis. Even minor changes can affect billing accuracy and reimbursement rates. |
- Missing or Incomplete Documentation
The ordering physician’s notes must justify the test’s necessity, as payers may deny reimbursement if clinical documentation is insufficient.
Additionally, the radiologist’s report should be thorough and correspond to the billed CPT codes. Ambiguous reports may lead to claim denials or delayed reimbursements.
- Payer Reimbursement Policies
Payers frequently update their policies. Regularly check payer guidelines and incorporate any changes to avoid non-compliance and unexpected denials.
Many payers require pre-authorization for high-cost imaging tests, such as MRIs and CT scans. Neglecting pre-authorization can result in denials, especially with managed care organizations.
| Checklist: Confirm payer policies on bundling, pre-authorization, and global services. Keep payer contact information readily available for quick pre-authorization verification. |
- Global Services and Bundled Payments
Some payers bundle multiple services into a single payment, meaning they may combine technical and professional fees into one rate, especially for routine services.
Familiarize yourself with payer-specific bundling rules to avoid underpayment. Misbilling for services that should be bundled can lead to unnecessary claim denials. Here’s an example for your better understanding:
Medicare frequently bundles diagnostic imaging services. Misinterpreting these rules led to underpayment issues for a radiology group, which they resolved by designating a team member to review payer bundling policies.
Best Practices for Accurate Radiology Billing
Here are strategies to help radiology practices improve billing accuracy, reduce errors, and receive timely reimbursement.
- Clear Communication Between Physicians
Ensuring consistent communication between ordering and rendering physicians can reduce documentation errors and ensure that the correct CPT and ICD-10 codes are used.
- Regular Billing Reviews and Audits
Frequent billing reviews can identify inconsistencies and highlight areas for improvement. This is especially important for practices where multiple radiologists and billing staff are involved.
| Quick Tip: Schedule a monthly audit to catch coding errors and prevent repeated issues. |
- Stay Informed on Coding and Billing Guidelines
Regular training on the latest billing and coding updates can prevent outdated practices that may lead to claim denials. Check resources from the American College of Radiology (ACR) and CMS for the latest updates.
- Consider Partnering with a Billing Service
Outsourcing radiology billing to a specialized service allows practices to focus more on patient care instead of getting caught up in the complexities of billing. Billing experts are knowledgeable about the details of medical coding, bundling rules, and payer requirements, ensuring everything is handled accurately and efficiently.
Final Thoughts
Accurate radiology billing relies on understanding the roles of ordering and rendering physicians, accurate coding, thorough documentation, and staying updated with payer regulations. Best practices such as clear communication, regular billing reviews, and using up-to-date software help reduce errors and optimize reimbursement.
These strategies streamline the billing process, improve revenue cycle efficiency, and allow radiology practices to focus more on patient care. For additional support, partnering with a specialized billing service offers the expertise needed to manage the complexities of radiology billing.
