Radiology Billing Guide 2026: CPT Codes, TC/PC Modifiers & RVUs

Radiology billing has a structural feature that most other specialties lack: the global-technical-professional split. Every diagnostic imaging service can be billed as a global code (technical component plus professional component together), a technical component only (the equipment, supplies, and technologist), or a professional component only (the physician’s interpretation and report). Getting this split right, matching your billing structure to your actual practice arrangement, is the foundational billing decision in radiology.This guide covers the TC/PC modifier system, global billing scenarios, RVU-based reimbursement, the most common diagnostic imaging code families, and the denial patterns that most frequently affect radiology practices and imaging centers in 2026.

The Global-Technical-Professional Framework

Most diagnostic imaging CPT codes have three billing versions:

• Global (no modifier), covers both the technical component (TC) and professional component (PC) together. Used when the same entity owns the equipment AND employs the interpreting physician.
• Technical component only (modifier -TC), covers equipment, supplies, staff, and facility overhead. Used when a hospital or independent imaging center performs the study and bills only for the technical work.
• Professional component only (modifier -26), covers the radiologist’s interpretation, dictation, and report. Used when a radiologist reads studies performed at a facility they do not own.

 Practical example: A hospital imaging center performs a CT of the chest (71250). The hospital bills 71250-TC for the equipment and technologist. The radiologist group employed by a separate radiology practice bills 71250-26 for the interpretation. If a private freestanding imaging center owned and staffed by the same radiology group performs and interprets the CT, they bill 71250 global.

Common Radiology CPT Code Families

Plain Radiography (X-Ray)

• 71046, Chest X-ray, 2 views
• 71048, Chest X-ray, 4 or more views
• 72100, Spine, lumbosacral, 2 or 3 views
• 73070, Elbow, 2 views
• 73560, Knee, 2 views

 

CT Imaging

• 71250, CT thorax without contrast
• 71260, CT thorax with contrast
• 71270, CT thorax without and with contrast
• 74177, CT abdomen and pelvis with contrast (high-value combined study)
• 70553, MRI brain with and without contrast
• 72148, MRI lumbar spine without contrast

 

Ultrasound

• 76700, Ultrasound, abdominal, complete
• 76705, Ultrasound, abdominal, limited
• 76856, Ultrasound, pelvic, complete
• 76870, Ultrasound, scrotal
• 93971, Duplex scan, extremity veins, unilateral

 

Nuclear Medicine and PET

• 78816, PET scan, limited area, with CT
• 78816, PET/CT whole body
• 78452, Myocardial perfusion imaging, SPECT
• 78300, Bone scan, whole body

 

RVU-Based Reimbursement: Understanding Your Radiology Revenue

Medicare and most commercial payers reimburse radiology services based on the Resource-Based Relative Value Scale (RBRVS). Each CPT code has a total RVU composed of three components:

• Work RVU (wRVU), reflects physician time and intensity. For the professional component, the wRVU compensates interpretation complexity.
• Practice Expense RVU (PE RVU), reflects overhead costs. Significantly higher for TC (facility equipment and staff) than PC (physician overhead).
• Malpractice RVU (MP RVU), reflects professional liability insurance costs.

 Total RVUs are multiplied by the Medicare Conversion Factor (CF), updated annually, to produce the Medicare payment rate. In 2026, the CF is approximately $33.89 per RVU. A CT of the abdomen and pelvis (74177) with a total global RVU of approximately 11.0 pays approximately $373 globally; TC pays roughly $285 and PC pays roughly $88.Why this matters for radiology revenue: Radiology practices that negotiate commercial contracts based on Medicare multiples must understand their RVU baseline. A contract at 140% of Medicare for diagnostic imaging generates 40% above the CF-adjusted RVU rate for every code billed. Track your RVU production monthly by code family to understand where your revenue comes from.

Interventional Radiology Billing

Interventional radiology procedures are billed with procedure codes from the surgery CPT section, frequently with accompanying imaging guidance codes. Unlike diagnostic radiology, interventional radiology often has no TC/PC split, it is typically billed globally because the same physician performs both the intervention and any associated imaging guidance.

• 36011, Selective catheter placement, venous, first order
• 36246, Selective catheter placement, arterial, first order, abdominal/renal/visceral
• 37220, Revascularization, endovascular, iliac artery, transluminal angioplasty
• 49442, Percutaneous nephrostomy catheter placement
• 77012, CT guidance for needle placement
• 76942, Ultrasound guidance for needle placement

 Imaging guidance codes (77012, 76942, 77002) are separately billable when image guidance is used to direct a procedure, but they require documentation confirming that real-time imaging was used, the number of images obtained, and that the images were permanently stored in the patient record.

Mammography Billing

• 77066, Diagnostic mammography, bilateral
• 77067, Screening mammography, bilateral (with CAD)
• 77065, Diagnostic mammography, unilateral

 Coverage note: Screening mammography is covered annually for women age 40 and over under Medicare and most commercial plans (ACA-mandate). A diagnostic mammography ordered for specific symptoms or findings uses a different code and typically involves patient cost-sharing. Do not bill diagnostic codes for screening orders, verify the ordering indication before code selection.

Common Radiology Billing Denials in 2026

Global Billing When TC-Only Is Appropriate

A radiology group bills the global code for studies read at a hospital facility they do not own. The hospital has already billed the TC. Result: duplicate billing denial and potential overpayment recoupment. Audit your billing arrangements: if you do not own the equipment and facility, you should be billing -26, not global.

Missing Medical Necessity for Advanced Imaging

CT and MRI studies ordered without documented medical necessity for the specific clinical indication are denied. The ordering physician’s documentation must link the specific clinical finding or symptom to the specific imaging study. ‘Evaluate’ is not a clinical indication; ‘evaluate for pulmonary embolism following acute onset dyspnea and elevated D-dimer’ is.

Frequency Limitation for Screening Studies

Screening mammography billed more frequently than annually for average-risk patients, or screening colonoscopy billed before the applicable interval. Frequency denials are automatic and non-appealable without medical necessity documentation.

Imaging Guidance Code Without Permanent Record Documentation

Billing 77012 or 76942 without documentation that real-time imaging guidance was used and that permanent images were stored. This is a common interventional radiology denial on audit. Every imaging guidance claim needs a specific statement in the procedure note confirming guidance use and image storage.

Incorrect Modifier Use (TC vs. -26 vs. Global)

Applying the wrong modifier for the actual billing arrangement, often caught when a payer’s claim processing detects that both the TC and global code were submitted for the same study. Audit your modifier assignments against your facility contracts quarterly.

Radiology Billing Optimization Strategies

Radiology revenue optimization starts with the basics: correct modifier assignment for every claim, accurate procedure code selection for the specific imaging study performed (not just the modality), and complete documentation for all imaging guidance codes. From there, the highest-impact opportunities are:

• Negotiate commercial contracts with RVU-based fee schedules rather than flat-fee schedules, RVU-based contracts automatically adjust revenue when code complexity increases.
• Audit your top-20 code pairs for TC/PC accuracy quarterly, this is where the largest systematic billing errors hide.
• Build a medical necessity documentation feedback loop with your referring physicians, radiology denials for missing medical necessity are their documentation problem, and you need their help solving it.

 Right On Time Medical Billing manages radiology and imaging center billing, TC/PC modifier accuracy, global billing arrangements, interventional radiology coding, and denial management, for radiology practices and freestanding imaging centers across all 50 states. Contact us for a free radiology billing assessment