Direct Answer
Radiology billing splits into professional and technical components for most imaging procedures. The professional component (Modifier 26) — the radiologist's interpretation — is billed separately from the technical component (Modifier TC) — the facility's cost of performing the scan (equipment, technologist, supplies). When the same entity performs both (a physician-owned imaging center), the global code (no modifier) is billed. Understanding when to bill global vs. split, how to code imaging studies by modality and contrast status, and how supervision requirements affect non-radiologist ordering provider billing are the foundations of accurate radiology coding.
Table of Contents
Technical vs. Professional Component Billing
Many radiology CPT codes are "split" codes — they have both a technical component (the work of performing the scan: equipment, technologist, physical facility) and a professional component (the radiologist's interpretation and written report). When a hospital or independent imaging center performs the scan, they bill the technical component (CPT code + Modifier TC). The radiologist who interprets the study bills the professional component (CPT code + Modifier 26). When a physician-owned office performs both the scan and the interpretation, the global code (no modifier) is billed — and the physician must both directly supervise the performance of the study and provide a personally signed, documented interpretation to bill the global code.
Billing the global code in a setting where the technical component belongs to a separate entity (e.g., a hospital) is a billing error. Billing Modifier 26 without providing a separately documented written interpretation is also a compliance error — the professional component requires a distinct, signed written report, not just a verbal or informal comment in the clinical note.
CT and MRI Coding
CT codes are organized by body region and contrast status: CT Head/Brain (70450 without contrast, 70460 with contrast, 70470 without and with contrast); CT Chest (71250/71260/71270); CT Abdomen (74150/74160/74170); CT Pelvis (72192/72193/72194); CT combined Abdomen and Pelvis (74176/74177/74178). The contrast status must match what was actually administered — coding a contrast study when no contrast was given is a billing error. MRI codes follow a similar structure by body part and contrast status (e.g., MRI Brain: 70551/70552/70553; MRI Spine cervical: 72141/72142/72156). CTA (CT angiography) and MRA (MR angiography) have their own codes separate from standard CT/MRI. When ordering a CT and MRI of the same body part at the same encounter, both codes may be appropriate if both were medically necessary and performed — but this combination draws audit scrutiny and requires clear documentation of the distinct clinical indication for each modality.
X-Ray and Ultrasound Codes
Plain film X-ray codes (710XX–730XX range) are coded by body part and number of views. Multiple-view studies have higher-valued codes than single-view studies — coding the number of views accurately matters. Ultrasound codes (760XX–769XX) are organized by body region (complete vs. limited abdomen, obstetric by gestational age and trimester, musculoskeletal, vascular). The "complete" vs. "limited" distinction in ultrasound is important: a complete abdominal ultrasound (76700) requires examination of liver, gallbladder, common bile duct, pancreas, spleen, kidneys, and upper abdominal aorta; if fewer than all required structures are examined (due to limited acoustic window or focused clinical question), code 76705 (limited) is appropriate. Billing a complete ultrasound code for a focused limited examination is an overcoding error.
Nuclear Medicine and PET
Nuclear medicine codes cover organ-specific scans using radioactive tracers: bone scan (78300/78305/78306/78315 based on number of areas), thyroid scan (78012/78013/78014), hepatobiliary scan (78226/78227), cardiac nuclear stress (78451–78454), and others. PET (positron emission tomography) codes cover whole-body PET (78816), limited area PET (78814/78815), and cardiac PET (78432/78433). PET/CT fusion codes (78814–78816 for oncologic imaging) combine the CT and PET into single codes — separate CT codes should not also be billed when the PET/CT fusion code is used for the same scan. Radiotracer (the radiopharmaceutical) is billed separately as a supply using HCPCS A-codes (A9500 for F-18 FDG, etc.) in addition to the procedure code.
Imaging Supervision Requirements
CMS assigns supervision levels to imaging procedures that affect who can perform them in a physician office setting: general supervision (physician need not be present during performance of the procedure, but must be available); direct supervision (physician must be immediately available to provide assistance, not necessarily in the room); personal supervision (physician must be in the room during the procedure). For physician office imaging billing (global code, no modifier), the ordering/supervising physician must comply with the applicable supervision level for each imaging service. Billing office imaging services when the supervising physician is not present as required by the supervision level for that code is a billing compliance violation — particularly relevant for physician offices that perform imaging.
FAQ
Can a primary care physician bill for interpreting imaging they ordered in their office?
A physician may bill the professional component of an imaging service (Modifier 26) if they own or lease the imaging equipment and the patient was not at a hospital or independent imaging center, AND if they provide a separately documented written interpretation of the study. The interpretation must be: personally performed by the billing physician (not delegated to a technician); documented as a separate written report (not just a brief notation in the visit note); and independently substantive — not just restating the technician's description. However, non-radiologist physicians billing imaging interpretation codes face payer scrutiny and potential denials on the basis that the interpretation was not by a qualified radiologist. Payer policies on non-radiologist interpretation billing vary — some commercial payers require the interpreter to have completed a radiology residency or demonstrate specific imaging training for certain modalities.
How are fluoroscopy and X-ray guidance codes billed with procedures?
Fluoroscopy (radiologic guidance) used during a surgical or interventional procedure is often an add-on or separately reportable service. For example, fluoroscopic guidance for needle placement during a joint injection (77002) is separately billable when used. However, NCCI edits bundle fluoroscopy or X-ray guidance into many procedures where it is considered a standard component — you cannot always add imaging guidance codes to a procedure just because a fluoroscope was in the room. The correct approach: check NCCI edits for each procedure code and proposed imaging guidance add-on code before billing; confirm that the clinical documentation specifically documents the use of imaging guidance and that the guidance was medically necessary and used in real time to guide the procedure (not just available as a precaution).
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