Radiology Billing & Coding Guide
Professional (26) vs technical (TC) component split, contrast administration, IR procedures.
Common Radiology CPT Codes
Ranked by claim frequency, with current MPFS work RVUs and global periods.
| Code | Description | Work RVU | Total RVU | Global |
|---|---|---|---|---|
| 71045 | X-ray exam chest 1 view | 0.18 | 0.76 | XXX |
| 71046 | X-ray exam chest 2 views | 0.21 | 0.99 | XXX |
| 71047 | X-ray exam chest 3 views | 0.26 | 1.23 | XXX |
| 71048 | X-ray exam chest 4+ views | 0.30 | 1.35 | XXX |
| 73030 | X-ray exam of shoulder | 0.18 | 1.07 | XXX |
| 73080 | X-ray exam of elbow | 0.17 | 0.99 | XXX |
| 73110 | X-ray exam of wrist | 0.17 | 1.28 | XXX |
| 73130 | X-ray exam of hand | 0.17 | 1.14 | XXX |
| 73501 | X-ray exam hip uni 1 view | 0.18 | 1.01 | XXX |
| 73502 | X-ray exam hip uni 2-3 views | 0.21 | 1.46 | XXX |
| 73600 | X-ray exam of ankle | 0.16 | 0.97 | XXX |
| 74018 | Radex abdomen 1 view | 0.18 | 0.89 | XXX |
| 74019 | Radex abdomen 2 views | 0.22 | 1.08 | XXX |
| 74021 | Radex abdomen 3+ views | 0.26 | 1.26 | XXX |
| 74022 | Radex compl aqt abd series | 0.31 | 1.48 | XXX |
| 74176 | Ct abd & pelvis w/o contrast | 1.70 | 5.48 | XXX |
| 74177 | Ct abd & pelvis w/contrast | 1.77 | 8.99 | XXX |
| 74178 | Ct abd&plv wo cntr flwd cntr | 1.96 | 10.12 | XXX |
| 77067 | Scr mammo bi incl cad | 0.74 | 3.78 | XXX |
What Radiology practices are leaving on the table
High-value services that consistently get under-billed across the specialty. Each one is rooted in current 2026 fee schedule and policy updates.
MRI upper extremity imaging: practices routinely downcode 73721 (MRI joint lower extremity without contrast, 1.32 RVUs, ~$48 national average) when 73723 (without and with contrast, 2.1 RVUs, ~$77) clinically indicated. Training radiologists to justify and document gadolinium administration for internal derangement or infection workup captures ~$30 per case; 5 cases weekly = $7,800 annual uplift with zero compliance risk if medical necessity documented.
Bilateral mammography CAD inclusion: many EHRs default bill 77065 (unilateral diagnostic mammography with CAD, 0.79 RVUs) twice instead of 77066 (bilateral with CAD, 0.98 RVUs). Single code change in imaging order template: bilateral DM + CAD = 77066 (saves 2 claim submissions, improves payer processing, and captures correct reimbursement). Impact: 20 bilateral cases monthly at ~$20 per code selection = $4,800 annual.
Abdomen/pelvis CT protocol optimization: coders often miss 74178 (CT abdomen and pelvis without and with contrast, 1.96 RVUs) and bill 74150 + 74176 separately (unbundled, risky). Protocol audit showing dual-phase imaging justifies 74178 single code, eliminates bundling vulnerability, and captures correct RVU value. Impact: 8 cases weekly at ~$15 RVU swing = $6,240 annual with reduced audit exposure.
Bone imaging whole body (78306) under-utilized for oncology staging: practices miss 78306 (bone imaging whole body, 0.84 RVUs, ~$31) when skeleton survey ordered for metastatic workup and instead bill individual skeletal region codes. Educate ordering physicians on bone scan appropriateness; cross-train coders on 78306 recognition. Estimated 2-3 missed cases monthly = $744-$1,116 annual uncaptured revenue.
Code pairs that auto-bundle to CO-97
From the National Correct Coding Initiative for Radiology. The rationale tells you when a modifier legitimately bypasses the edit and when it cannot.
CT head without contrast (70450) bundles with CT head with contrast (70460). Bill only 70470 (without and with contrast) if both are clinically indicated on same session. Modifier 59 does not bypass this; separate clinical scenarios and provider notes stating medical necessity for sequential imaging required to defend.
Chest X-ray 1 view (71045) bundles with 2-view chest (71046). Report the comprehensive code matching actual views performed. CMS/MACs do not recognize modifier 59 for view-count progression on same imaging session.
CT abdomen without contrast (74150) bundles with CT abdomen with contrast (74160). Report 74170 (without and with) if both phases performed. Modifier 59 defensible only if distinct anatomy or new acute clinical event documented between imaging phases.
MRI lumbar spine without contrast (72148) bundles with MRI lumbar spine with contrast (72158). Report 72158 if both phases needed. Documentation must show medical justification for contrast phase (e.g., suspected infection, tumor staging) to avoid denial under bundling rules.
Modifier Guidance for Radiology
When each modifier legitimately applies in this specialty, with denial-pattern context and audit-defense documentation.
Modifier 25 applies when a significant, separately identifiable E/M service (office visit, consult) is performed on the same day as the radiology procedure and results in independent clinical decision-making. Example: Patient presents with chest pain, physician performs comprehensive H&P (99213-25), orders and interprets chest X-ray (71046-25). Both codes separately reimbursed because the E/M was not simply ordering the imaging.
Modifier 59 used sparingly in Radiology. Legitimate use: distinct anatomic sites on same session (e.g., CT chest 71270 and CT abdomen 74150 on same day for trauma). NCCI and MAC LCDs increasingly restrict 59; use XS or XU when available. Documentation requirement: separate clinical indications and anatomic regions in the radiologist's report.
Modifier GP used when imaging services are delivered as part of an outpatient physical therapy plan of care (e.g., ultrasound of shoulder as component of PT protocol). Rarely used in standard Radiology billing unless the imaging is ordered by PT and documented in PT plan. Do not default to GP; confirm medical necessity language in PT documentation.
Modifier TC (technical component only) used when billing separately for equipment, technician, and supplies without physician interpretation. Example: Radiology center performs US acquisition; radiologist remote reads and bills 26 (professional only). Payer contracts must explicitly allow TC/PC splits or claim will bundle to global.
Modifier LT/RT required when bilateral procedures cannot use modifier 50 or when unilateral procedure performed. Example: 73030-LT (single shoulder X-ray left) or 77065-RT-77065-LT (bilateral diagnostic mammography with CAD, right and left). Payer systems flag missing side modifiers as incomplete data.
Documentation requirements
What needs to live in the encounter note for these codes to survive a payer audit.
- Clinical indication documented in order and radiologist report: specifies anatomy, symptom, or condition prompting imaging. Supports medical necessity defense in denials.
- Contrast administration details if applicable: type (IV, oral), timing, volume, and patient reaction. Required for contrast-based code selection (70460 vs 70450).
- Comparison statements: note prior imaging dates and comparison findings. Establishes baseline and supports follow-up imaging bundling defenses.
- Number of images and views acquired: especially for X-rays (chest, abdomen, extremities). Determines correct CPT level and prevents over-coding or downcoding.
- Radiology report signature and interpretation date: mandatory for professional component billing and RAC post-payment audits.
- Protocol used (e.g., 'standard chest protocol,' 'CT with arterial and portal venous phases'): justifies code selection and defends against bundling challenges when multiple phases or techniques are standard of care.
OIG and audit triggers in Radiology
Patterns that show up in OIG Work Plans, RAC audits, and CERT improper payment reviews. Build internal compliance checks around these.
OIG 2025 Work Plan targets Radiology overpayments via unbundling: MACs audit CT pairs (70450/70470, 74150/74170, 74176/74178) billed with modifier 59 lacking clinical distinction. Defense requires radiologist's contemporaneous documentation stating separate clinical scenarios or anatomic regions; absence triggers automatic recoupment of 100% overpayment plus interest.
RAC pattern: bilateral procedures (73030-50, 77066, 78306) deny when modifier 50 applied to codes with inherent bilateral inclusion or when submitted as two separate units instead of one unit with modifier 50. Audit findings show 40% of RAC bilateral disputes traceable to billing system configuration. Ensure billing software recognizes 50-modifier as single service, not duplicate line item.
Prior authorization denials for advanced imaging (MRI, CT) spike when orders lack specific clinical indication linked to LCD coverage criteria. Medicare MACs require reference to symptom duration, failed conservative care, or imaging finding triggering advanced study. Claims without this documentation deny as 'not medically necessary' (CARC 50); resubmission requires manual peer-to-peer review.
Contrast administration documentation gaps trigger False Claims Act scrutiny if 70460 (with contrast) billed but chart shows 'contrast not tolerated' or 'allergy note in record.' OIG special fraud alert on contrast coding requires radiologist attestation of actual administration. Claims lacking this evidence subject to claim-level recoupment and potential qui tam liability.
Payer-specific billing notes
Where the major payers diverge from generic Medicare rules in Radiology.
ME Medicare +
CMS LCD L33822 (CT/MRI coverage for spine, brain, and thorax) requires documented indication and specifies non-coverage for screening or symptom-limited exams without objective findings. Prior authorization not universally required but MAC varies by region (e.g., Noridian requests prior auth for advanced brain MRI). 2026 update clarifies contrast protocols: bundling of phases strictly enforced unless radiologist documents separate clinical decision point between acquisitions. NCCI edits enforced monthly; radiology practices must subscribe to NCCI/MAC updates quarterly.
UN UnitedHealthcare +
Optum delegates Radiology medical policy to eviCore for advanced imaging (MRI, CT above $500 POP value). eviCore requires specific clinical indications tied to evidence-based guidelines (ACR Appropriateness Criteria). Prior authorization turnaround 24-48 hours for emergency/urgent; 3-5 business days routine. Denial for 'fails conservative care' if no documentation of NSAIDs, physical therapy, or steroid injection attempt. UHC enforces bilateral code logic strictly; modifier 50 claims without 'performed on both sides' language in operative note deny routinely.
AN Anthem +
Anthem ICR (Imaging Clinical Review) uses AI triage for CT/MRI; claims flagged for missing elements auto-deny and require manual re-submission. Anthem AIM (Anthem Imaging Management) medical policy requires specific contraindication documentation if contrast contraindicated (e.g., eGFR <30 for IV contrast). Prior auth processing 2-3 business days; claims without auth numbers deny with CARC 50. Anthem does not recognize modifier 59 for view-count bundling (chest X-rays, abdomen series); only global code appropriate.
CI Cigna +
Cigna eviCore delegation for oncology radiology (PET, advanced staging CT) requires treatment plan documentation from oncology. Radiology-only imaging (diagnostic mammography, routine ultrasound) not subject to eviCore preauth. Cigna medical policy specifies bilateral procedure reporting: modifier 50 or dual RT/LT submission both accepted, but billing system must reflect 'one patient encounter' or dual claim submits deny as duplicate. Recent 2025 policy update restricts MRI lumbar spine (72158) to post-operative follow-up or failed conservative care; new-onset low back pain claims require peer-to-peer review.
Standard Radiology coding workflow
Step 1: Verify imaging order in EHR, confirm clinical indication, and check payer's prior authorization requirement (Medicare LCD, UHC eviCore, Anthem AIM). Step 2: Match imaging modality and protocol to CPT code hierarchy (X-ray views, CT phases, MRI planes) using radiologist's acquisition summary. Step 3: Apply contrast and laterality modifiers (50, LT, RT, TC, 26) per protocol documentation and payer rules. Step 4: Cross-reference NCCI edits and MAC bundling pairs; apply 59/XS/XU only with documented clinical distinction. Step 5: Audit claim for missing elements (indication, comparison, signature, report date) before submission to reduce soft denials.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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