The nature of radiology billing services could soon be changing.
As radiology medical billing stands now, revenue cycle processes don’t accurately reflect the extensive work they do outside of image interpretation. These tasks can take up anywhere from 35% to 60% of their time. They can include work like consultations for their colleagues or traveling to attend conferences to review cases with professionals from other specialties.
But a recent study from Yale School of Medicine examines this dynamic, looking at gaps in billing for services performed by radiologists and making recommendations to close gaps in radiology medical coding and billing [1]. Revenue cycle leaders who bill for radiology services should consider reviewing this study and the recommendations to better understand the challenges your clinicians face and the changes that could soon be coming to radiology medical billing.
The Complexities of Radiology Billing Services
Radiology billing requires significant attention to detail because of the nature of imaging procedures.
Billers and coders must properly capture charges for X-rays, CT scans, and MRIs. Services like interventional radiology require precise coding with appropriate modifiers to avoid denials and delays in payment. One thing that sets radiology medical billing apart is the separation between the professional component (physician interpretation) and the technical component (equipment and staff). When a single entity provides both, a global charge applies, but in hospitals, split billing is common since radiologists bill separately for interpretations.
Compliance is also a challenge in radiology billing. It is complicated by supervision requirements, payer-specific policies, and the need for thorough documentation, which must align to avoid denials. High-cost imaging also demands rigorous validation to support medical necessity. Revenue cycle leaders must invest the time and training in their staff to achieve these fundamentals. Without them, the risk of revenue leakage increases, making expertise in radiology medical coding indispensable.
The Hidden Workload: Unbilled Consultations in Radiology
Uncompensated efforts from radiologists should be a concern for healthcare leaders.
These differences can impact patient care, but unfortunately, current contract and billing structures aren’t set up to capture their efforts or generate reimbursement. Even electronic consultation codes for interprofessional calls or assessment and management services that occur through the electronic health record (EHR) which could serve as a temporary solution, are underutilized due to documentation hurdles.
According to the study authors, “such codes could theoretically provide a means of billing consultative work by radiologists, though there are practical barriers to use. Billing requires documentation of patient consent, which would likely need to be performed by the requesting physician in the case of ad hoc radiology consultation. These codes are [generally] reimbursed at lower RVU per unit time than E&M codes (as well as pathology consultation codes), which may not provide sufficient incentive for practices to implement new workflows, unless streamlined documentation and billing mechanisms can be put in place.”
The absence of structured billing processes for these services creates a financial gap, forcing providers to absorb the cost of unreimbursed labor. As radiology billing evolves, the demand for consultative roles will only grow. This inevitable growth makes it critical for leaders in radiology billing services to advocate for solutions that reflect the full scope of their radiologists’ contributions.
Burnout in Radiologists Is a Pressing Issue
The hidden workload of radiologists should be a priority for healthcare leaders, largely because of their risk of burnout.
Burnout in radiologists often shows up as exhaustion, cynicism, and diminished self-worth. It’s also reached critical levels. 65% of female and 44% of male radiologists report that they feel burned out or both burned out and depressed. Even though physician burnout rates have stabilized some in recent years, 71% of affected radiologists have endured it for more than 13 months [2].
Burnout is associated with higher rates of turnover, reduced productivity, and an increase in medical errors – issues that cost health systems millions in recruitment and lost revenue. The American Association of Medical Colleges (AAMC) warns that radiology can’t afford to lose any more talent, since the specialty is already dealing with imaging overuse, stagnant residency slots, and the “silver tsunami” of aging Boomers.
Closing the Gap: Strategies for Fair Compensation
To address these inefficiencies, Yale researchers propose a few solutions. One is dedicated CPT codes similar to those in pathology. These could account for ad-hoc and multidisciplinary consultations. Another is negotiating hospital contracts to include stipends for noninterpretive work or implementing academic RVU models to track unbilled hours for individual radiologists.
Health systems can benefit from long-term incentives for consultations, especially as AI is used to streamline routine interpretations and free radiologists up for more complex case discussions.
Academic and referral centers could benefit the most from restructured reimbursement models since consultative work is most prevalent in these organizations.
Get in Front of Changes in Radiology Billing Services
As more professionals rethink this area of the healthcare revenue cycle, expect to see changes in radiology billing and even growing opportunities to improve reimbursement. These changes will have reverberating effects across your organization and aren’t something providers should try to navigate alone.
We invite you to learn more about how 3Gen Consulting can support you in your radiology billing strategy and to contact us to learn more about the range of options you have in leveraging our expertise. Start your journey to improvements in your revenue cycle strategy here.
References
[1] S. Iftikhar, S. Rahmani, O. A. Zaree, A. Kertam, T. Farquhar and L. H. Tu, “The Value of Radiology Consultation: Effort Allocation, Clinical Impact, and Untapped Opportunities,” Journal of the American College of Radiology, 7 April 2025.
[2] C. E. Hudnall, “Burnout Fueling Workforce Woes,” 3 July 2024. Available: https://www.acr.org/Clinical-Resources/Publications-and-Research/ACR-Bulletin/Burnout-Fueling-Workforce-Woes.
