Skip to content Credex Healthcare is a specialist radiology billing company built specifically for the volume, velocity, and technical precision that imaging revenue cycle management demands. Whether your practice is a hospital-based radiology group managing global billing splits, a free-standing imaging center running high-volume diagnostic studies, a teleradiology operation billing professional reads across multiple states, or an interventional radiology practice navigating complex procedure billing, we manage your complete radiology billing cycle so every image your radiologists read generates the full reimbursement it deserves, on the first submission.
First-Pass Claim Acceptance Rate Across Radiology Payers
Claim Submission Turnaround After Radiology Report Sign-Off
Insurance Payers Including Medicare Advantage and Medicaid Plans
Modifier 26 and TC Split Billing Compliance Across All Claims
Every radiology claim that leaves our system has passed through a four-point review calibrated to the specific failure modes of imaging billing. We confirm that the CPT code selected for each study accurately reflects the study ordered, performed, and documented in the radiology report.
We make sure that modifiers 26 and TC are correctly assigned to each claim by checking whether the tools and places are owned or rented. This keeps technical component refund issues from happening. We also check that the ordering provider’s paperwork meets the standards for medical necessity set by the payer and make sure that the patient’s insurance plan requires prior authorization for advanced imaging. A 98% first-pass rate is possible thanks to these checks.
Our radiology billing services in the USA cover the following:
Within 24 to 48 hours of receiving the radiology report, we prepare and electronically send the claims. For each transfer, we include confirmed CPT codes, correct modifier 26 and TC assignments, ICD-10 diagnosis codes from the ordering documentation, and prior permission numbers.
We get radiologists, teleradiologists, and interventional radiology providers approved by Medicare, Medicaid, and commercial payers in all active states and practice locations. We also handle re-attestation cycles, so billing does not stop when your group adds doctors or expands its coverage.
Within 24 hours of an imaging claim being rejected, the reason for the denial is reviewed. We appeal with supporting documents before the payer's filing date, even if the rejection is due to a modifier error, a dispute over medical necessity, a gap in prior permission, or a disagreement between global and split billing.
Our trained radiology coders review imaging reports, order paperwork, and charge entries to make sure that the CPT codes match the study performed and that the ICD-10 codes in the buying provider's notes meet the medical-necessity standards for the paid mode.
We manage prior authorization requests for advanced imaging, including MRI, CT, PET, and nuclear medicine studies, for private and Medicaid plans as needed. To prevent high-value imaging claims from being denied after the fact, we track the authorization status and when it expires.
From patient insurance verification and ordering provider documentation receipt through payment posting and AR recovery, we manage your complete radiology revenue cycle end-to-end, so no imaging study ages past 45 days without active follow-up on every open balance.
Radiology billing is a national problem with local rules and practices that treat it as a single uniform process, which pays for that assumption in denials. Medicare processes radiology claims through regional MACs that apply jurisdiction-specific payment policies for imaging services, and the correct billing entity for a given study depends on whether the practice owns its equipment outright, operates under a lease arrangement with a hospital, or reads studies remotely under a teleradiology agreement, each of which changes the modifier structure and the global versus split billing approach that applies to every claim.
Medicaid programs in each state maintain separate prior authorization mandates for advanced imaging, covering criteria for CT and MRI that differ from Medicare and from one another. Commercial payers apply proprietary prior authorization programs through radiology benefits managers such as EviCore and Carelon that impose their own clinical criteria for imaging necessity, independent of the ordering physician’s judgment. Credex Healthcare tracks radiology billing rules across all of these layers, so your claims reflect the right modifier structure, the right entity billing, and the right documentation for every payer your patients carry.
We apply CMS payment policies for diagnostic imaging, correct modifier 26 and TC assignments based on your billing arrangement, global billing rules for practices that own equipment, and Medicare coverage criteria for advanced imaging modalities, including MRI, CT, and PET scanning.
We manage state-specific Medicaid radiology billing requirements, including prior authorization mandates for advanced imaging, fee schedule compliance, and managed care organization submission rules that vary significantly across state programs and MCO contracts.
We handle radiology benefits manager prior authorization programs through EviCore, Carelon, and payer-specific UM vendors, benefit verification, and imaging claims submission for BCBS, Cigna, Aetna, UnitedHealthcare, and regional carriers across all active payer contracts.
We bill professional component reads for teleradiology groups operating across multiple states, managing multi-state licensure compliance, correcting POS and modifier application for remote reads, and payer enrollment in every jurisdiction where your radiologists interpret studies.
Radiology billing failures do not come from random payer behavior. They stem from five specific, recurring errors that a specialist billing team prevents before any claim reaches the clearinghouse. Modifier misassignment is the most pervasive: submitting a global bill under a CPT code when the practice should have split the claim into a professional component under modifier 26 and a technical component under modifier TC, or splitting a claim where the practice performs both components and the global bill was appropriate, creates a billing error that either under-reimburses the practice or triggers a payer conflict that delays payment by weeks.
Medical necessity failures on advanced imaging are the second-leading cause, in which a CT or MRI claim is denied because the ordering provider’s diagnosis documentation used an unspecified ICD-10 code when the specificity the payer requires was available and documentable. Prior authorization gaps on commercial imaging claims under radiology benefits management programs are the third, where a study is performed and billed without a confirmed authorization number, and the claim is denied in full post-service, with an average value of $800 to $3,500 per episode. Credex Healthcare closes every one of these failure points before a single claim leaves the system.
We verify that every rendering radiologist is individually enrolled with the target payer under the correct group TIN, that teleradiologist enrollment reflects the state of study interpretation rather than the state of practice location, and that all enrollment records are current before claims are submitted.
Our coders confirm that each imaging CPT code reflects the study performed, the modality used, the body part imaged, and whether contrast was administered, and that the correct global, modifier 26, or modifier TC billing approach is applied based on the practice's equipment ownership and billing arrangement.
We review radiology reports, ordering physician documentation, and imaging requisitions to confirm that ICD-10 diagnosis codes establish medical necessity at the specificity level the payer requires and that the clinical indication documented supports the imaging modality billed.
We manage authorization requests through radiology benefits manager portals, including EviCore and Carelon, track authorization numbers against study scheduling dates, and confirm that every advanced imaging claim is submitted with a valid and unexpired authorization before transmission.
We verify HCPCS coding for contrast materials and radiology supplies on all applicable claims, ensuring that contrast-enhanced studies capture the full billable value of the contrast agent administered and that supply codes are applied in compliance with payer-specific coverage policies.
AR Follow-Up
All open radiology claims are tracked through a structured AR follow-up process segmented by payer and aging bucket, with escalation protocols for high-value imaging claims that have exceeded 45 days without payment or a formal payer determination on the outstanding balance.
Credex Healthcare addresses all these issues prior to claim submission. We identify and close each of these patterns from the first billing cycle we manage. Our billers and coders know that radiology billing failures largely stem from five recurring errors that can be prevented. We specialize in managing modifiers with proper assignments, ensuring complete reimbursement without any delays.
We have extensive knowledge and a deep understanding of advanced imaging and specified ICD-10 codes. Our team also fills all the gaps in prior authorization for commercial imaging claims, resulting in no denied claims. Additionally, correct HCPCS coding for contrast agents on CT and MRI claims leads to full reimbursement.
We submit radiology claims with verified CPT codes, correct modifier 26 and TC assignments, contrast-supply HCPCS codes, prior authorization numbers, and ICD-10 diagnosis codes from ordering documentation, targeting first-pass acceptance and eliminating revenue lost to modifier and supply coding errors.
Our radiology coding specialists review imaging reports and ordering documentation to confirm CPT code accuracy, appropriate modifier assignment, and ICD-10 medical-necessity compliance for every study type across plain film, CT, MRI, ultrasound, nuclear medicine, and interventional radiology.
Prior Authorization Management
We initiate and track prior authorizations through radiology benefits manager portals for all advanced imaging requiring pre-approval, monitoring authorization status against study scheduling, and confirming authorization numbers are attached to every applicable claim before submission.
Every denied radiology claim is reviewed within 24 hours, categorized by root cause, and either corrected with the correct modifier or supporting documentation and resubmitted, or formally appealed with the imaging report and ordering physician documentation before the payer's filing deadline.
We credential radiologists and interventional radiology providers with Medicare, Medicaid, and commercial payers across all active states and practice locations, managing multi-state teleradiology enrollment and recredentialing cycles to keep billing active everywhere your group reads.
Monthly reports cover your clean claim rate by modality and CPT code category, modifier compliance metrics, denial breakdown by payer and root cause, prior authorization approval rates, contrast billing performance, AR aging, and net collections trend for full revenue cycle visibility.
Radiology and Diagnostic Imaging Revenue Cycle Expertise
Provider Enrollment Coverage for All Active Radiology Rosters
HIPAA Compliance Rate Across All Billing Operations
Dedicated Billing Support for Radiology Practices and Groups
Customized Billing Workflows for Every Radiology Practice Model
Hospital-Based Group Practice
Alan Forsythe
“We had been submitting global bills on studies where we should have been splitting the professional and technical components, and nobody caught it for almost 18 months. Credex identified the pattern in the first week of their billing review. The modifier correction alone recovered the material amount of revenue we had been leaving in a billing limbo. Their knowledge of modifier 26 and TC billing in a hospital-lease arrangement is exactly what we needed.”
Free-Standing Imaging Center
Sander
“Our authorization gap rate had crept up to nearly 6% without anyone realizing it because the denials were trickling in weeks after the studies. Credex set up a process for tracking authorizations that were linked to our scheduling system. In the first two billing cycles, our rejection rate for commercial imaging tests dropped from 14% to less than 3%. The income rebound happened right away and was big.”
Multi-State Coverage
Idris
“Billing teleradiology professional reads across eight states means managing eight sets of payer enrollment records, eight sets of licensure requirements, and eight different commercial payer credentialing timelines. Credex is in charge of all multi-state enrollments and makes sure that all of the radiologists in the group are up to date in all areas. Our claims acceptance rate across all states has stayed above 97%.”
Academic Medical Center
Nakamura
“Our old biller always got things like the difference between a diagnostic and a therapeutic angiogram wrong, the right way to code image-guided biopsy vs. drainage treatments, and the rules for bundling fluoroscopy guidance codes in the wrong way. Credex got them right from the start. The number of failed treatment claims dropped from 18% to 4%, and we stopped having to deal with the problem of post-payment audit recoupments.”
Outpatient Radiology Group
Marcus
“We run five image centers in two states, and as we add more locations, our billing gets more complicated. Credex handled the full onboarding across all five sites simultaneously, found contrast HCPCS coding gaps we didn’t know existed, and in 90 days raised our overall first-pass rate to over 98%. The difference in first-pass rates between 91% and 98% for a group of our size means millions of dollars in cash flow. Credex made it possible to see and measure that difference.”
Practice and Billing Arrangement Assessment
We take a close look at your current claims data, billing plan, and payer types. For radiology practices, this evaluation focuses on your compliance with modifier 26 and TC in your facility agreements and equipment ownership, as well as your prior authorization gap rate across commercial imaging panels, the completeness of your contrast HCPCS coding, and any teleradiology multi-state enrollment gaps.
Credentialing and Payer Enrollment
We make sure that each radiologist and interventional radiology provider in your group has the appropriate credentials and is registered with each payer under the correct group TIN and billing plan. We also make sure that teleradiologists are registered in every state where studies are read and paid for.
Modifier, Authorization, and Documentation Workflow Setup
We set up prior authorization tracking workflows that integrate with your scheduling system, enabling advanced imaging studies and ICD-10 documentation review checkpoints for ordering provider referrals. We do this by working with your billing and administrative team to make sure that the modifier assignment protocols are correct for each facility-payer relationship.
Clean Claim Submission
Before an electronic claim is sent, every radiology claim is checked to make sure that the CPT code matches the imaging report correctly, that the right modifiers are applied based on how the practice bills, that the contrast supply HCPCS code is complete, that the ICD-10 medical necessity rules are followed, and that the prior authorization number is attached.
Denial Management and Appeals
Within 24 hours of receiving them, denied imaging claims are reviewed and put into groups. Our rejection team can tell the difference between modifier mistakes, medical-necessity disputes, prior permission failures, comparison-billing problems, repeat-claim conflicts, and payer-judgment errors. For each, they then plan the right way to fix the problem.
Reporting and Ongoing Optimization
Every month, we review this data with the leaders of your group and make changes to the billing process to reflect changes in MAC payment policies, imaging benefits manager criteria, and any new rejection patterns identified in your claims data before they become an ongoing income problem.
Credex Healthcare knows a lot about imaging because it is a field with a lot of claims, and those are very complicated. Our team is very sure that a doctor reading a CT scan in an outpatient area of a hospital under a lease agreement should be billing marker 26 for the professional part.
In addition, we know that EviCore and Carelon handle radiology benefits for large business plans and need approvals through their own sites before an MRI or CT claim can be handled. Our billers and coders use different, well-organized HCPCS numbers for contrast agents.
Our billing team stays up to date on the latest radiology CPT code categories across all imaging modalities, as well as modifier 26 and TC assignment rules for all billing arrangements. They are also familiar with radiology benefits manager prior-authorization portals, contrast HCPCS supply coding, and the medical-necessity criteria for advanced imaging used by Medicare and commercial payers.
You work with a named radiology billing account manager who understands your group's billing arrangement, your payer contracts, and your study mix across every modality you operate. Your account manager will let you know if a radiology benefits manager changes its imaging requirements or a MAC changes its payment policy, before it shows up in a rejection.
Every month, we send each client a detailed report that includes the number of claims by modality, the first-pass acceptance rate, modifier compliance metrics, denials broken down by CPT code category and payer, prior authorization performance, AR aging, and net collections trend. The report also includes plain-language explanations of what the numbers mean for your group's revenue cycle.
Credex Healthcare handles all radiology billing in a fully HIPAA-compliant environment that includes encrypted PACS and RIS data integration, secure electronic claim transmission, and audited access controls on all patient imaging records and billing data.
Credex Healthcare offers a free radiology billing audit to qualifying practices and groups. The audit covers your modifier assignment compliance across your active billing arrangements, your prior authorization gap rate on commercial imaging panels, your contrast HCPCS coding completeness, your CPT code accuracy across your highest-volume study categories, and your current AR aging profile.
There is no commitment required beyond the audit session, and most radiology groups surface at least one material and recoverable revenue gap in the first review. The only cost of waiting is the revenue you keep leaving behind.
Radiology medical billing includes the whole process of getting paid for imaging services, from ordering the study to sending payment. It involves choosing the right CPT codes for different imaging modalities, such as radiography, CT, MRI, and invasive treatments. It’s important to be correct when showing imaging details and billing parts. As part of our services, we check patients’ insurance, handle prior authorizations, prepare claims, handle denials, and make payments.
Radiology CPT codes are organized by imaging methods and body area. The imaging mix at a practice affects the high-frequency codes. Plain film x-rays show that 71045 (single-view chest) and 71046 (two-view chest) are important. Some CT scan codes are 70450 (brain CT without contrast) and 74177 (abdominal CT with contrast). The MRI numbers 70553 (brain MRI with/without contrast) and 72148 (lumbar spine MRI without contrast) are used a lot.
In radiology bills, modifiers 26 and TC are very important but are often used incorrectly. When a facility bills the technical part, modifier 26 is used to indicate that only the doctor’s work is being billed, like when they analyze or write reports. Modifier TC, on the other hand, means payment for only device use and expert services. It is used when the study is interpreted by a different company.
In imaging, lowering claim rejections means keeping an eye on modifier compliance, medical necessity paperwork, prior permission compliance, contrast HCPCS billing, and tracking repeat claims. Run weekly checks to find similar CPT codes and avoid rejections and compliance issues.
The billing industry is rapidly evolving. By the year 2025, the system and tools used
Billing companies ensure compliance with HIPAA and other regulations by being legitimate and reliable. Every
At Credex Healthcare, we know how frustrating it is when claims are denied. That is
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