Procedure-Specific Billing
Specialized Billing for Every Radiology Service
Each radiology service type carries its own component billing rules, MPPR reduction calculations, prior authorization requirements, and medical necessity documentation standards. ProtoMed's certified team ensures every imaging study is billed at its full, compliant reimbursement value.
TC/PC/Global Component Billing
The most fundamental billing decision in radiology is whether a study is billed globally, as a technical component only, or as a professional component only. This depends on who owns the equipment, who performed the interpretation, and where the study was conducted. Applying modifier -TC to a global claim or billing globally when only the professional component was provided results in denied or overpaid claims. We correctly identify and apply the right component billing approach on every imaging encounter.
Advanced Imaging & Prior Authorization
MRI, CT, PET, and advanced nuclear medicine studies require prior authorization from most commercial payers, and a missing authorization means the entire study is denied regardless of medical necessity. We manage prior authorization requests for advanced imaging modalities, build clinical documentation packages that satisfy payer criteria, track authorization timelines, and ensure every advanced imaging study has confirmed authorization before it is performed.
MPPR Compliance & Underpayment Recovery
Medicare's Multiple Procedure Payment Reduction reduces reimbursement by 50% on the second and subsequent imaging studies performed in the same session on the same patient. Payers must apply MPPR correctly, and when they apply it incorrectly or apply it when the studies were performed in different sessions, the result is a recoverable underpayment. We calculate expected MPPR-adjusted reimbursements on every multi-study claim and identify and contest underpayments when payers apply reductions incorrectly.
Interventional Radiology Billing
Interventional radiology combines procedural coding with imaging guidance add-on codes, selective catheter placement codes, and separate billing for contrast media and supplies. Each intervention requires complete documentation of access site, catheter position, and procedure performed, and the imaging guidance codes must be applied correctly alongside the primary procedure codes. We accurately code every IR encounter, capturing procedure codes, imaging guidance add-ons, and separately billable supplies at their full reimbursement value.
Nuclear Medicine & PET Billing
Nuclear medicine billing involves radiopharmaceutical-specific HCPCS codes, separate technical and professional component billing, and prior authorization for PET scans and advanced nuclear studies. Radiopharmaceutical dosage and drug administration codes must be billed separately from the imaging interpretation. We accurately code every nuclear medicine and PET encounter, manage authorization requirements, and ensure radiopharmaceutical billing captures the full drug and administration cost.
Medical Necessity & Denial Management
Radiology studies are among the most frequently denied claims for medical necessity: payers require documented clinical indications that justify the specific imaging modality ordered. When a radiologist's report lacks the supporting clinical context, denials follow. We manage medical necessity documentation for advanced imaging studies, build appeal packages for denied claims with the clinical evidence required for reversal, and identify denial patterns to prevent recurrence across your imaging volume.
