Radiological Billing

Maximize your reimbursements with radiology-specialized billing. We manage 2026 CPT coding changes, professional/technical components, and denials to optimize revenue for your diagnostic imaging practice.

Radiology billing has always been one of the most technically complex specialties in healthcare revenue cycle management. However, in 2026, the complexity reached unprecedented levels. With 288 new CPT codes, 84 deletions, 46 revisions, and a 26-31% reduction in reimbursement for head and neck computed tomography angiography (CTA) due to new grouping rules, radiology departments are facing a critical situation due to regulatory changes. Add to this the replacement of six lower limb revascularization codes with 46 new territorial codes, the expansion of pre-authorization requirements for high-cost imaging procedures, and the constant pressure of insurer-driven medical necessity reviews, and it becomes clear why generalist billing companies are struggling to keep up.

At MedMaxbill, Inc., we offer comprehensive radiology billing services designed to help you navigate these 2026 complexities. Our team of certified radiology coders understands the specific revenue cycle requirements of diagnostic imaging practices, from split billing of professional and technical components and new CPT code transitions to denial management and regulatory compliance, ensuring your practice captures every dollar earned while maintaining full regulatory compliance.
 

The 2026 Radiology Billing Landscape: Critical Updates

1. Conversion Factor and Medicare Payment Changes

CMS finalized two conversion factors for 2026: $33.4009** for nonqualified APM participants (a 3.26% increase) and $33.5675 for QP (a 3.77% increase). However, this increase is offset by structural changes that reduce reimbursement for many radiology services, particularly those performed in hospital settings.

2. Lower Extremity Revascularization (LER): The Largest Coding Overhaul

The 2026 CPT update eliminated six codes (37220-37235) and replaced them with 46 new codes (37254-37299) for percutaneous lower extremity revascularization. These codes are now defined by territory (iliac, femoral/popliteal, tibial/fibular and new inframalleolar territory) and complexity of the lesion (simple stenosis versus complex occlusion).
 

Critical Documentation Requirements:

Medical documentation must clearly specify whether the case is simple (stenosis) or complex (occlusion).

The determination is based on the vessel's condition immediately before the procedure.

Intravascular lithotripsy (IVL) codes are only available for the iliac and femoral/popliteal regions.

All codes include catheterization and image guidance through the same access site.

3. Head and Neck CT Angiography Grouping: A Significant Reimbursement Reduction

The new CPT code 70471 (head and neck CT angiography), which is being grouped, replaces the separate billing of codes 70496 and 70498. Impact on Payment:

Billing Note: Separate codes (70496, 70498) remain available only when each study is performed separately for different indications.

4. Cerebral CT Perfusion: From Category III to Category I

Category III code 0042T has been removed and replaced with Category I codes 70472 (complementary) and 70473 (independent), improving reimbursement potential.

5. Billing by Professional and Technical Components

Radiology services are distinguished by having two distinct components:

Professional Component (Modifier -26): Physician interpreter's work.

Technical Component (Modifier -TC): Equipment, technician, and facility costs.

Common Errors:

Billing the wrong component.

Not applying component billing when components are provided by different entities.

Not coordinating with referring physicians.

6. Head and Neck Embolizations

Significant revisions were made to codes 61624 and 61626. Image guidance components (75894, 75898) are now billed as a complete package and cannot be billed separately.

7. Prostate Biopsy Codes

Prostate biopsy codes have been updated to better define the type of image guidance used: MRI-ultrasound fusion biopsy, image-guided targeted biopsies, and stereotactic guidance each have distinct codes.

8. Irreversible Electroporation (IRE)

New Category I codes have been established for percutaneous IRE of the liver and prostate. The existing Category III code (0600T) should be used for IRE ablation of any other organ.

9. Prior Authorization for Ambulatory Surgical Centers (ASCs)

CMS expanded prior authorization requirements for imaging services. Radiology centers must ensure proper prior authorization to avoid payment reviews and payment delays.

10. Decreased Reimbursement and Increased Insurer Control

Between 2007 and 2022, the average reimbursement for radiology services decreased significantly. Insurers are demanding stricter documentation of medical necessity, AI-assisted imaging is expanding procedure codes, and denial rates in radiology typically range from 8% to 15%.
 

The Most Costly Radiology Billing Errors

1. Confusion in LER Coding

With 46 new codes replacing 6, clinics that don't transition immediately face automatic denials. Territory-based coding, complexity classification, and additional coding rules are often misinterpreted.

2. Error in Grouping CTAs

Billing codes 70496 and 70498 separately for a combined head and neck CTA results in denials from Medicare (and many private insurers). The new code 70471 should be used.

3. Missing -26 or -TC Modifier

Failing to apply the correct modifier for the professional or technical component results in denials or underpayments. For example, billing for a lump sum service when only the professional component was performed leads to claim rejection.

4. Obsolete Codes

With 84 CPT codes being phased out by 2026, clinics still using obsolete codes face immediate denials. Key codes removed include the six LER codes (37220-37235), 0042T, and numerous imaging codes for head and neck embolization.

5. Insufficient Documentation to Justify Medical Necessity

High-cost imaging tests (MRI, CT, PET) are frequently audited to determine medical necessity. Lack of documentation regarding functional disability, unsupported preoperative testing, or the absence of a clear indication result in denials.

6. Deficiencies in Pre-Authorization

Pre-authorization standards for imaging tests were tightened in 2026. Failure to obtain authorization at the time of request results in a pre-payment review or denial. With denial rates of 8 to 15 percent in radiology, authorization failures represent a significant loss of revenue.
 

Our Comprehensive Radiology Billing Services

Assistance with the Transition to CPT 2026 Codes

Our certified radiology coders ensure that all claims use the updated 2026 codes, including:

46 new LER codes (37254-37299) with the correct territory and complexity classification.

70471 for combined head and neck computed tomography angiography (CTA), replacing codes 70496 and 70498.

70472 and 70473 for computed tomography (CT) brain perfusion (replacing code 0042T).

Revised codes for head and neck embolization (61624 and 61626) with integrated image guidance.

Billing split by professional and technical components

We guarantee accurate split billing for each radiology service, applying the modifier -26 for professional interpretation and -TC for technical processing. Our team verifies which entity performed each component, preventing duplicate billing and potential audits.

Documentation support for LER coding

We collaborate with providers to ensure that documentation clearly specifies:

Vascular territory (iliac, femoral/popliteal, tibial/peroneal, inframalleolar)

Lesion status: simple (stenosis) or complex (occlusion)

Specific interventions performed (angioplasty, stent placement, atherectomy, intravascular lithotripsy)

Whether intravascular lithotripsy was performed only in the iliac territory or in the femoral/popliteal territory

Prior Authorization Management

We manage prior authorizations for high-cost diagnostic imaging services (MRI, CT, PET, interventional procedures), ensuring authorization is obtained before services are provided and avoiding prepayment review delays.

Denial and Appeal Management

Each denied claim is reviewed and appealed with supporting documentation, including injury classification/territory LER, justification for CTA grouping, and medical necessity documentation. We analyze denial trends by payer and service to implement preventative strategies.

Accounts Receivable Monitoring and Recovery

Our accounts receivable specialists proactively monitor outstanding balances, maintaining days sales outstanding (DSO) below 35 days and recovery rates above 98%.

Regulatory Compliance and Audit Support

We help you keep your documentation audit-ready, particularly for:

LER Injury Classification Records

Medical justification of CTA (Critical Trauma Testing)

Verification of professional/technical components

Tracking of prior authorizations
 

Why MedMaxbill for Radiology Billing?

Specialized Radiology Expertise: 

Our coders work exclusively with radiology cases, not with generalists who rotate between specialties. We understand split billing of professional/technical components, CPT 2026 transitions, and payer-specific image edits that generic billing firms often overlook.

2026 Compliance Ready: 

We stay current with 288 new CPT codes, 46 new LER codes, CTA grouping (70471), CT brain perfusion codes (70472, 70473), and Medicare conversion factor updates.

Proactive Denial Prevention: 

By identifying LER coding confusion, CTA grouping errors, incorrect application of component modifiers, and deficiencies in pre-authorization before claims submission, we significantly reduce denial rates from 8-15% to less than 5%.

Revenue protection: 

Our systematic approach prevents the 26-31% reimbursement loss resulting from CTA bundling and guarantees full reimbursement for high-value LER procedures.

Dedicated support: 

You will have access to a dedicated account manager who understands your practice and is available to answer questions and provide updates.
 

Partner with MedMaxbill for Radiology Billing Success

Radiology billing demands a specialized approach. With 46 new LER codes, cuts in CT angiography (CTA) billing, increasing complexity in professional and technical components, and growing scrutiny from insurers, generalist billing companies often lose significant revenue and expose clinics to the risk of regulatory noncompliance.

At MedMaxbill, we combine industry expertise, advanced technology, and ongoing support to ensure your radiology practice maximizes revenue and achieves full regulatory compliance in 2026 and beyond.

Partner with MedMaxbill, Inc. and enjoy the peace of mind that comes with expert radiology billing services. Let us handle the complexities of billing so you can focus on what matters most: providing exceptional imaging care.