Radiology
Radiology
Radiology is the highest-volume billable specialty in U.S. medicine, and the rules are not negotiable. The defining concept is the global vs professional vs technical (26 / TC) split: hospital-based radiologists bill the professional component only (modifier 26), freestanding imaging centers bill global, and independent diagnostic testing facilities (IDTFs) bill technical only (modifier TC). Most denials trace back to a setting-modifier mismatch. Beyond that, every modality has its own landmines: contrast tiers (without, with, or without-and-with are three different codes), the CT abdomen-and-pelvis bundle (74176 / 74177 / 74178 supersedes billing CT abdomen plus CT pelvis separately), multi-procedure reduction on the technical component, and the screening-versus-diagnostic distinction in mammography with cost-share waiver modifiers. Subspecialty rules layer on top: PET-CT staging codes (78815 / 78816 / 78814) are anatomy-stratified, MPI codes (78451 / 78452) are study-count stratified, and interventional radiology stacks selective catheter codes (36245 / 36246 / 36247) with imaging guidance codes (76942 / 75710 / 75716) per vascular territory.
Top billed codes
The codes that drive revenue in this specialty. Click any code for documentation requirements, modifiers, and pitfalls.
| Code | Description | wRVU | Total RVU | Medicare $ | |
|---|---|---|---|---|---|
| 71046 | Chest x-ray, 2 views Use 71046 when both a frontal (PA or AP) and a lateral image are acquired, which is standard for non-portable chest imaging. Common indications: cough or dyspnea workup, low-suspicion chest pain (when ACS is not leading), hemoptysis, pulmonary nodule follow-up, pre-operative clearance, blunt thoracic trauma screening. Use 71045 for a single view (typical of portable AP supine), 71047 for three views (often added rib obliques), 71048 for four-plus views (dedicated rib series, detailed apical survey). Pick by total views actually obtained on the encounter, not by clinical question. | 0.22 | 0.89 | $30 | Details → |
| 70450 | CT head/brain, without contrast 70450 is the first-line head CT for acute neurological complaints when MRI is unavailable or contraindicated. Common indications: suspected acute stroke (rule out hemorrhage before tPA), head trauma, sudden severe headache (rule out SAH), altered mental status, suspected hydrocephalus, post-fall in anticoagulated patient. 70460 (with contrast) and 70470 (without and with) are reserved for mass evaluation, infection, or known intracranial pathology requiring contrast characterization. Do not bill all three (70450, 70460, 70470) on the same date for the same patient. | 0.85 | 3.07 | $103 | Details → |
| 70551 | MRI brain, without contrast Use 70551 for non-acute brain MRI when contrast is not required. Common indications: subacute or chronic headache evaluation, seizure work-up, neurodegenerative disease characterization (dementia, MS), trigeminal neuralgia, sensorineural hearing loss screening, pituitary microadenoma screening, white matter disease assessment. 70552 (with contrast) is required for tumor characterization, infection (encephalitis, meningitis), MS activity, post-treatment surveillance. 70553 (without and with) is the standard for MS protocol, tumor characterization, and most oncology surveillance. | 1.48 | 7.41 | $248 | Details → |
| 71250 | CT chest, without contrast Use 71250 when chest CT without contrast is the indicated study: pulmonary nodule follow-up per Fleischner Society guidelines, interstitial lung disease evaluation, COPD/emphysema characterization, pre-operative thoracic surgery planning, suspected pulmonary fibrosis. 71260 (with contrast) is used for hilar mass, mediastinal lymphadenopathy, post-treatment oncology surveillance. 71270 (without and with) is reserved for complex cases requiring both characterizations. 71275 (CTA chest) is the PE-protocol study with timed contrast bolus and is a different code. For Medicare low-dose CT lung cancer screening, use G0297 (the screening-specific HCPCS code) instead of 71250. | 1.08 | 3.57 | $119 | Details → |
| 74176 | CT abdomen and pelvis, without contrast Use 74176 when both abdomen and pelvis are imaged without IV contrast in the same encounter. The canonical indication is the renal stone protocol (CT KUB) for suspected nephrolithiasis. Other indications: assessment of contraindication to IV contrast (severe CKD without dialysis, prior anaphylactoid reaction), urgent post-trauma screening when contrast cannot be obtained, gas-pattern evaluation for SBO when contrast would interfere. 74177 (with contrast) is the workhorse for most other abdominal/pelvic indications; 74178 (without and with) is reserved for complex characterizations such as adrenal mass or post-treatment oncology. | 1.74 | 6.08 | $203 | Details → |
| 74177 | CT abdomen and pelvis, with contrast 74177 is the first-line CT for abdominal pain, suspected appendicitis, diverticulitis, abscess, cholangitis, pancreatitis severity grading, oncology staging and surveillance, post-operative complications, and unexplained sepsis. The IV contrast highlights vascular structures, bowel-wall enhancement, and solid-organ pathology. 74176 (no contrast) is the alternative when contrast is contraindicated. 74178 (without and with) is reserved for adrenal mass characterization, complex cystic lesion evaluation, and selected oncology protocols. 74174 (CTA abdomen + pelvis) is a vascular study with timed bolus and a different indication set. | 1.82 | 7.16 | $239 | Details → |
| 72148 | MRI lumbar spine, without contrast Use 72148 when the workup of low back pain or lumbar radiculopathy requires advanced imaging and contrast is not indicated. Standard indications: persistent radiculopathy after 6 weeks of conservative care, suspected disc herniation, spinal stenosis evaluation, post-laminectomy recurrence (without enhancing tissue suspicion), cauda equina screening (when concerning symptoms but no overt red flags). 72149 (with contrast) and 72158 (without and with) are reserved for suspected tumor, infection (discitis, osteomyelitis), or post-operative recurrence requiring contrast to distinguish enhancing scar from disc. | 1.48 | 7.18 | $240 | Details → |
| 73721 | MRI lower extremity joint, without contrast Use 73721 for knee, ankle, foot, or hip joint MRI without contrast. Most common indication: knee internal derangement evaluation (meniscal tear, ACL/PCL/MCL tear, chondral injury) after failed initial conservative management. Other indications: ankle ligament tear (lateral collateral, syndesmotic), avascular necrosis screening (hip, talus), Achilles or other tendon rupture characterization, occult fracture in trauma. 73722 (with contrast) and 73723 (without and with) are reserved for tumor, infection, or MR arthrogram protocols. | 1.48 | 7.18 | $240 | Details → |
| 76700 | Abdominal ultrasound, complete Use 76700 when a comprehensive abdominal survey is performed and all required organs are imaged. Standard indications: RUQ pain workup (gallstones, cholecystitis, cholangitis), elevated LFTs, suspected cirrhosis, abdominal mass, organomegaly, ascites characterization, and pre-treatment baseline for chronic liver disease. 76705 (limited abdomen) is used for a focused question (e.g., "gallbladder only") or when only specific organs are imaged. | 0.81 | 2.28 | $76 | Details → |
| 76830 | Transvaginal ultrasound Use 76830 for transvaginal ultrasound of the female pelvis. Common indications: early pregnancy dating, fetal viability assessment (in the first trimester), suspected ectopic pregnancy, abnormal uterine bleeding, postmenopausal bleeding workup, suspected adnexal mass, IUD positioning, evaluation of pelvic pain. Pair with 76856 (pelvic ultrasound non-OB complete) or 76801-76817 (OB-specific codes) if a separate transabdominal pelvic study is also performed in the same session. | 0.69 | 2.25 | $75 | Details → |
| 76536 | US soft tissue head/neck (thyroid) Use 76536 for thyroid ultrasound (the most common indication) or imaging of other soft-tissue structures in the head and neck (salivary glands, parotid mass, cervical lymphadenopathy, parathyroid localization). Standard thyroid indications: thyroid nodule evaluation, monitoring known nodules per TIRADS or ATA guidelines, TSH abnormality workup with palpable thyroid abnormality, follow-up post-thyroidectomy or radioiodine ablation. Often paired with 76942 (US guidance for needle placement) when biopsy is performed. | 0.59 | 3.22 | $108 | Details → |
| 76942 | US needle placement guidance 76942 is the workhorse ultrasound guidance code, bundling the imaging supervision and interpretation when a needle procedure (biopsy, aspiration, injection, central venous access, paracentesis without imaging-bundled parent code) is performed under real-time US guidance. Common pairings: thyroid FNA (60100 + 76942), soft tissue mass biopsy (10005 + 76942), shoulder bursa injection (20610 if without guidance, but 20611 is the US-guided major joint version that bundles 76942), peripheral nerve block, abscess drainage. Permanent recording in the chart is required for billing. | 0.67 | 2.08 | $69 | Details → |
| 77067 | Screening mammography, bilateral Use 77067 for routine bilateral screening mammography in an asymptomatic patient meeting eligibility criteria (typically age 40+ for commercial, age 40+ for Medicare). Cannot be used when the patient is symptomatic, has a palpable abnormality, or is being recalled from a prior screening — those are diagnostic mammography (77065 unilateral or 77066 bilateral). Often paired with 77063 (3D tomosynthesis screening add-on) when DBT is performed alongside the 2D screening views. | 0.70 | 3.53 | $118 | Details → |
| 77065 | Diagnostic mammography, unilateral Use 77065 when diagnostic (not screening) mammography is indicated for one breast: callback from screening abnormality, palpable mass or focal pain, nipple discharge, focal asymmetry on prior imaging, post-treatment surveillance for breast cancer (often only the treated side). 77066 is bilateral diagnostic. Add 77061 (DBT diagnostic unilateral) when tomosynthesis is also performed. | 0.74 | 3.41 | $114 | Details → |
| 93880 | Carotid duplex, bilateral complete Use 93880 for bilateral complete carotid duplex ultrasound: B-mode imaging plus spectral Doppler analysis of the common, internal, and external carotid arteries on both sides, including peak systolic and end-diastolic velocity measurements. Standard indications: TIA or stroke workup, carotid bruit on examination, screening of high-risk patients (CAD, PVD, abdominal aortic aneurysm), post-CEA or CAS surveillance. 93882 (limited) is the unilateral or limited follow-up version. | 0.65 | 3.15 | $105 | Details → |
| 78815 | PET-CT, skull to mid-thigh Use 78815 for the skull base to mid-thigh PET-CT field, which is the standard for most adult oncology indications: lymphoma (initial staging, mid-treatment response, end-of-treatment), lung cancer staging, colorectal cancer staging or recurrence, head and neck cancer surveillance, breast cancer (when indicated), esophageal cancer, melanoma staging, and many other solid tumors. 78816 (whole body) is reserved when distal-extremity coverage is clinically needed (rare; melanoma with distal extremity primary, multi-site disease). 78814 (limited area) is for a focal anatomic region only. | 1.94 | 12.57 | $420 | Details → |
| 78451 | Myocardial perfusion imaging, single study Use 78451 when a single MPI study (rest only OR stress only) is performed. 78452 (multiple studies) is the standard for the workhorse rest-and-stress combination — the most common MPI workflow. 78453 / 78454 are planar (now rare) versions. Pair with stress test supervision and interpretation (93016 supervision, 93018 interpretation) when a treadmill or pharmacologic stress is performed in your facility. | 1.46 | 6.06 | $202 | Details → |
| 36245 | Selective catheter, abd/pelvic, 1st order Use 36245 when a first-order branch is selectively catheterized in the abdominal aorta or its branches (renal artery, celiac, SMA, IMA, common iliac, external iliac) for diagnostic angiography or to deliver therapy (embolization, chemoembolization, stenting). 36246 is the second-order branch (e.g., right renal segmental, hepatic proper from celiac), 36247 is the third or further order (e.g., dorsal pancreatic from celiac, intrarenal segmental). Each catheter selection in a NEW vascular family is separately billable; multiple selections in the same family stack with order codes. | 4.67 | 6.68 | $223 | Details → |
| 49083 | Paracentesis with imaging guidance Use 49083 when paracentesis is performed with real-time imaging guidance (ultrasound is most common; fluoroscopy in rare cases). Standard indications: diagnostic paracentesis in new-onset ascites, large-volume therapeutic paracentesis for tense ascites, refractory ascites in cirrhosis, suspected spontaneous bacterial peritonitis (SBP), oncology-related malignant ascites. 49082 (without imaging) is rarely the right code now that bedside ultrasound is widely available; use 49082 only when imaging was truly not used. | 1.66 | 2.99 | $100 | Details → |
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