Radiology
AI-Powered Radiology Medical Billing and Coding Solutions
Accelerate radiology billing, coding, and RCM with AI agents that master complex imaging CPT/HCPCS codes, TC/26 splits, contrast rules, and payer-specific prior authorization and medical necessity workflows.
What Is Radiology Billing and Coding?
Radiology billing and coding involves converting diagnostic imaging services, X-rays, CT, MRI, ultrasound, fluoroscopy, nuclear medicine, and interventional procedures, into accurate, payable claims.
Coders assign precise CPT codes for imaging modality and anatomy, apply HCPCS codes for contrast and radiotracers, split technical (TC) and professional (26) components, and ensure modifiers for bilateral, multiple, and reduced services are correct per NCCI and payer rules.
Billers verify eligibility, secure prior authorizations for advanced imaging (MRI, CT, PET), capture all charges, submit clean claims, and appeal denials for medical necessity and documentation issues.
Technical vs Professional Component Splits
Radiology claims require accurate TC/26 splits; many payers use different fee schedules and denial rules for each component.
Impact: Underpayments or split-component denials
Contrast and Add-On Code Accuracy
Imaging with contrast, multiple sequences, or 3D reconstructions requires correct add-on codes and precise documentation of contrast type and administration.
Impact: Bundling denials and missed revenue for advanced imaging
Prior Authorization for Advanced Imaging
MRI, CT, PET, and nuclear studies often require PA with clinical indications, failed conservative treatment, and supporting documentation.
Impact: Claim delays, rejections, and patient care disruptions
Our Expertise in Radiology Billing and Coding
Amy: AI Medical Coding Agent for Radiology Care
- Codes radiology exams with precise CPT, HCPCS, and ICD-10 combinations for X-ray, CT, MRI, ultrasound, fluoroscopy, and nuclear medicine
- Applies TC/26 splits, bilateral modifiers, add-on codes for contrast, and NCCI bundling rules
- Flags missing laterality, clinical indication, contrast documentation, and supervision requirements
- Audits charts for imaging frequency limits, medical necessity, and correct anatomy/modality pairing
- Provides line-by-line rationale for each code ensuring compliance and audit transparency
Mark: AI Medical Billing Agent for Radiology Care
- Verifies eligibility across Medicare, Medicaid, and commercial payers for imaging services and prior authorization requirements
- Validates radiology-specific codes, TC/26 splits, contrast add-ons, and medical necessity before submission
- Submits claims and handles charge entry directly in your RIS/billing system
- Reads ERAs and scans paper EOBs to post payments and catch underpayments for imaging services
- Continuously learns from radiology denial patterns like CO-4 (modifier), CO-50 (medical necessity), and CO-97 (bundling)
Adam: AI Denial Management Agent for Radiology Care
- Checks claim status in real-time across payers for high-value imaging like MRI, CT, and PET
- Makes AI-driven calls navigating IVRs and agents for prior auth disputes and appeals
- Uses customizable scripts tailored to radiology workflows, including PA denials, frequency limits, and split-component disputes
- Manages outbound/inbound calls with full call tracking
- Provides recordings, summaries, and recommendations to resolve aging radiology claims faster
What are the common reasons for radiology claim denials?
How do TC and 26 modifiers work in radiology billing?
What ICD-10 codes are most used in radiology?
How does prior authorization work for advanced imaging?
How can AI improve radiology coding accuracy?
What are the best practices for radiology RCM?
Future-proof your Healthcare RCM with AI Workforce
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Email: info@combinehealth.ai
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