Radiology billing services for both sides of the component split

Radiology billing services manage the two mechanics that set imaging apart: the component split between the professional read and the technical service, and prior authorization run by radiology benefit managers. Codes in the imaging range, CPT 70010 to 79999, bill as a global service or split into modifier 26 and TC claims, and the wrong choice denies. Advanced imaging adds an authorization gate that sits with eviCore, Carelon, or HealthHelp rather than the payer. Flexbone runs eligibility, authorization, claim follow-up, and denial work for radiology groups and imaging centers.

How does global versus professional and technical component billing work?

An imaging service has two parts. The technical component covers the equipment, the technologist, and the supplies. The professional component covers the radiologist's interpretation. When one entity owns both, it bills the code globally with no modifier. When they split, the interpreting radiologist bills with modifier 26 and the facility bills with modifier TC. The billing pattern must match the setting: a hospital-based radiologist bills 26 only, because the hospital owns the technical side, while a freestanding center that employs its radiologists bills globally. Billing global when only one component was performed, or filing a 26 claim whose place of service contradicts it, denies. The radiology billing explainer covers the component logic in more depth.

How does prior authorization work in radiology billing?

On many commercial and Medicare Advantage plans, the authorization decision for advanced imaging sits with a radiology benefit manager, not the payer. MRI, CT, PET, and nuclear studies route through eviCore, Carelon, HealthHelp, or Evolent (formerly NIA, whose portal is RadMD), each with its own portal and its own clinical criteria. For billing, the failure modes are concrete. No authorization on file when the study was performed. An authorization that does not match the study billed, usually because the protocol changed after approval: an approval for MRI without contrast does not cover the with-contrast study performed. An authorization issued to the wrong site or provider identifier. Flexbone checks the requirement when the order arrives, submits through the benefit manager the plan uses, and verifies the approved CPT codes match the scheduled study before it is performed. The imaging and radiology PA page covers the modality rules.

Why do radiology claims deny?

Radiology denials concentrate where the workflow splits. Authorization denials: no approval on file, or an approved study that does not match the performed one. Component denials: 26 and TC errors, or a global claim filed when the components split. Eligibility denials: imaging patients arrive as referred orders, so the center often bills a patient it never registered by phone, and lapsed coverage surfaces only at adjudication. Running the 270/271 eligibility check when the order arrives catches that before the scan. Medical necessity denials follow the diagnosis codes on the order and need the clinical record to appeal. Flexbone maps the CARC and RARC codes on the 835 remittance, corrects and resubmits the mechanical failures, and assembles the record for the rest.

How does Flexbone run radiology billing?

Flexbone deploys browser and voice agents across the imaging revenue cycle. When a referred order arrives, agents verify eligibility, determine the authorization requirement, and submit through the benefit manager the plan uses. After the study, they follow the claim, reconcile the components, and work the denial queue inside your RIS and billing system. The front-office side, order intake, patient scheduling, and preparation calls, is covered on the AI for radiology page. Results write back with an audit trail, and exceptions route to your billers with context.