Radiology Medicaid rates by code

The radiology line groups the codes billed mostly by radiology groups, imaging centers and hospitals. Across the 51 state programs we cover, 682 codes in this line have a published fee-for-service rate in five or more states. By code set, the line is made up of 670 CPT radiology codes, 9 HCPCS Level II professional services codes and 3 HCPCS Level II diagnostic radiology codes.

How to read the index

• Code opens the code's page: every state's rate ranked, the unit, a per-hour figure for timed codes, the managed-care rule and a Medicare comparison where the units match.
• States is the number of state Medicaid programs that publish a fee-for-service rate for the code. A higher count makes the median more representative.
• Median rate is the middle published amount across those states, in the units they use. When states publish a code in different units, the median mixes them, so open the code before relying on it.

Why radiology rates differ between states

• Imaging fees are split into a professional component (the reading) and a technical component (the equipment and staff), and states publish one, the other or a global amount.
• Advanced imaging such as CT, MRI and PET is often under separate pricing and prior-authorization policies that vary from state to state.
• States that benchmark imaging to Medicare use different percentages and different Medicare years.
• Some states pay hospitals for the technical component through an outpatient system and pay only the professional component from the physician schedule.

Billing and units

Imaging is billed per study, with modifier 26 for the professional component and TC for the technical component; a claim without either is paid at the global amount where the state publishes one. Contrast agents and radiopharmaceuticals are usually billed separately under their own codes.