Radiology practices often overlook separate charges for key items, such as imaging supplies, contrast dye, and radioactive tracers, because they focus more on the primary scans and diagnoses. When staff neglect to bill for these costly materials, practices lose revenue and risk compliance violations.
A single error in billing for radioactive tracer can cost $1,000 or more per study. With Medicare reimbursement rates reduced by about 2.9% in 2025, these HCPCS pitfalls are more critical for radiology practitioners than ever before. This guide highlights common HCPCS pitfalls and proven strategies to eliminate them.
Why HCPCS Is Critical in Radiology Billing?
CPT codes capture what you do, the MRI scan, CT study, or PET scan procedure. HCPCS codes capture what you use, the $2,000 PET tracer, $300 gadolinium injection, or specialized catheter. Missing these supply codes means utilizing expensive materials as practice overhead instead of getting paid for them.
This happens constantly in radiology. Practices focus on the big-ticket imaging procedures but overlook the expensive materials that make those procedures possible.
The most common areas where practices lose revenue involve:
Contrast Agents
Each contrast type requires specific HCPCS codes based on composition and delivery method. Gadolinium-based MRI contrast uses different codes than iodinated CT contrast. Using generic codes instead of specific agent codes creates systematic underpayments.
Radiopharmaceuticals
PET imaging relies on expensive tracers with complex billing rules. Some codes bill per study dose regardless of millicuries used, while others bill per millicurie administered. This distinction determines whether you bill one unit or fifteen units for the same injection.
Interventional Supplies
Catheters, guidewires, and specialized devices used during interventional procedures often qualify for separate billing. Missing these charges transforms profitable procedures into break-even or loss scenarios.
Radiology Billing HCPCS Pitfalls and How to Avoid Them
The following are the most frequent HCPCS errors in radiology billing, with their solution.
Wrong Units for Radiopharmaceutical Billing
Radiopharmaceutical codes follow different billing rules that many practices misunderstand, leading to significant revenue loss.
The Problem
Some codes bill “per study dose,” while others bill “per millicurie.” Code A9503 covers up to 30 millicuries but bills as one unit regardless of the actual amount used. Many practices incorrectly bill 15 units when injecting 15 millicuries.
The Solution
Train staff to identify “per study dose” vs “per millicurie” descriptors. Create quick reference cards showing unit rules for commonly used radiopharmaceuticals.
Missing Documentation for Expensive Tracers
Unlisted tracer codes require extensive documentation that many practices overlook, resulting in denied claims.
The Problem
Codes like A9598 need product name, NDC number, dosage, and invoice cost documented. Missing any element triggers denials. Random audits demand invoice proof, and incomplete records mean repaying received funds.
The Solution
Create documentation templates for unlisted codes. Require invoice copies and complete product details before billing any NOC radiopharmaceutical codes.
Billing Contrast When It’s Already Included
Payer bundling rules vary significantly, creating confusion about when contrast can be billed separately.
The Problem
MRI contrast is bundled into procedure payments by certain payers. Billing separately violates contracts and triggers compliance reviews. Each payer has different bundling rules that change quarterly.
The Solution
Maintain current bundling reference guides for major payers. Review payer updates quarterly and adjust billing protocols accordingly for each contract.
Missing Contrast Documentation Details
Insufficient contrast documentation prevents proper HCPCS coding and creates systematic revenue loss.
The Problem
Type and amount of contrast must be documented in the technique portion before adding supply codes. Missing details about specific contrast agents, volumes administered, or delivery methods prevent accurate HCPCS code selection and reimbursement.
The Solution
Require technologists to document the exact contrast type, volume, and administration route. Create standardized templates for contrast documentation in imaging reports.
Prior Authorization Gaps for Expensive Agents
High-cost radiopharmaceuticals and contrast agents often require prior authorization, which practices frequently fail to obtain.
The Problem
Advanced PET tracers costing $3,000-$5,000 need pre-approval before administration. Missing authorization creates automatic denials regardless of medical necessity. Emergency studies compound this challenge when time doesn’t allow authorization requests.
The Solution
Implement pre-authorization tracking systems for high-cost agents. Verify coverage before scheduling and maintain authorization databases with expiration tracking.
Billing System Mapping Errors
Chargemaster systems often incorrectly map procedures to the wrong HCPCS codes, creating systematic billing errors.
The Problem
Technical staff capture bilateral imaging on charge tickets, but billing systems map to unilateral procedure codes. Therapeutic infusions get mapped to hydration codes. These mapping errors create consistent underbilling across multiple claims.
The Solution
Conduct quarterly chargemaster audits with both clinical and billing staff. Cross-check charge ticket descriptions against the actual HCPCS codes in your billing system. Where errors are found, update mappings immediately and use test claims to confirm corrections before going live.
Volume Calculation Mistakes
Incorrect dosage calculations lead to wrong unit billing and significant revenue variances.
The Problem
Per-milliliter codes require precise volume calculations. Practices billing per vial instead of actual milliliters administered miss revenue opportunities. Waste documentation requirements further complicate accurate unit determination for expensive agents.
The Solution
Train staff on per-unit vs per-volume billing distinctions. Implement dose calculation verification protocols. Document waste appropriately for expensive radiopharmaceuticals.
Incomplete Invoice Records for Audits
Missing invoice documentation creates vulnerability during payer audits and recovery demands.
The Problem
NOC codes require invoice cost documentation for payment. Practices often bill without maintaining proper invoice records. Random audits demand actual purchase receipts, and missing documentation results in immediate repayment requirements.
The Solution
Maintain invoice copies for all NOC code billing. Create audit-ready filing systems linking claims to purchase documentation. Verify invoice completeness before claim submission.
Impact of These HCPCS Pitfalls on Providers
Understanding the full scope of HCPCS errors helps practices prioritize prevention efforts and allocate resources effectively. These impacts extend far beyond simple billing mistakes, affecting practice sustainability and operational efficiency.
Immediate Financial Consequences
HCPCS errors create direct revenue loss that compounds quickly across multiple studies. In a moderate-volume practice, radiopharmaceutical unit billing mistakes can add up to six-figure annual losses, especially when PET scan volumes are high. Missing contrast documentation affects a large share of routine studies, creating consistent underpayments that may range from $50 to several hundred dollars per case.
The timing makes these losses especially painful. While imaging procedure payments arrive within 30-45 days, HCPCS supply charges often face additional scrutiny and delays. Denied supply claims require resubmission with corrected documentation, extending payment cycles to 90-120 days, and creating cash flow gaps.
Compliance and Audit Risks
Medicare and commercial payers increasingly target HCPCS billing in their audit programs. NOC code billing receives particular attention due to the high dollar amounts involved. Practices without proper invoice documentation face immediate repayment demands during audits, often with interest and penalties.
Bundling violations create contractual compliance issues beyond simple payment errors. Consistently billing separately for bundled supplies can trigger contract reviews and potential termination from payer networks. These compliance problems affect the entire practice, not just the imaging department.
Administrative Burden and Staff Impact
HCPCS errors consume significant staff time through denial management and resubmission processes. Billing teams spend hours researching denied claims, gathering missing documentation, and reprocessing corrected claims. This administrative burden reduces staff productivity and increases operational costs.
Training challenges compound the problem. HCPCS rules change frequently, and keeping staff current on unit billing, bundling requirements, and documentation standards requires ongoing education investments. Many practices struggle to maintain expertise across all HCPCS categories while managing daily billing volumes.
Best Practices for HCPCS Error Prevention
The solutions we mentioned above fix immediate problems, but lasting success requires systematic approaches to prevent errors before they occur. Here’s what you should do:
Establish Key Performance Indicators
- Track first-pass HCPCS claim acceptance rates monthly by modality.
- Monitor average days to payment for supply charges versus procedure codes.
- Measure denial rates specifically for NOC codes and contrast agents.
- Calculate monthly revenue recovered through improved HCPCS coding accuracy.
Create Accountability Systems
- Assign HCPCS compliance ownership to specific staff members.
- Implement peer review processes for high-dollar radiopharmaceutical billing.
- Establish escalation protocols when documentation requirements aren’t met.
- Require supervisor approval before billing any NOC codes.
Invest in Technology Solutions
- Deploy automated claim scrubbing focused on HCPCS-specific edit checks.
- Implement real-time eligibility verification for expensive agent coverage.
- Use AI-powered coding assistance to flag potential unit billing errors.
- Deploy reporting dashboards showing HCPCS performance trends and problem areas.
Develop Strategic Partnerships
- Partner with billing companies specializing in radiology HCPCS coding.
- Engage with professional associations for ongoing education and updates.
- Collaborate with software vendors for custom edit development.
- Work with legal counsel to ensure audit-ready documentation practices.
Conclusion
The path forward is clear: radiology practices must prioritize HCPCS accuracy to survive declining reimbursement rates. The solutions exist, the technology is available, and the training methods work; what matters now is implementation. Start with your highest-impact area first.
If you perform PET scans, focus on radiopharmaceutical unit billing. If contrast studies control the volume, fix documentation protocols immediately. These small improvements create immediate results, while systematic changes protect long-term revenue. Your practice’s financial future depends on getting HCPCS right, starting today.