Glossary: Radiology RVU & Billing Terms

A-C

ACR (American College of Radiology)

A professional organization that provides clinical guidelines, accreditation, and advocacy for radiology practices.

Allowance

The maximum amount a payor will reimburse for a specific procedure or service.

Authorization

Pre-approval from a payor required before performing certain radiology exams (especially MRIs, CTs, and nuclear medicine).

Bundled Services

When multiple procedures are combined under one reimbursement, often at a lower rate than if billed separately.

CPT (Current Procedural Terminology)

A set of codes developed by the AMA used to describe diagnostic and therapeutic procedures, including radiology exams.

CMS (Centers for Medicare & Medicaid Services)

The federal agency that oversees Medicare/Medicaid and sets the RVU values used in physician fee schedules.

Coding

The process of translating a radiology service into billing codes (e.g., CPT, ICD-10) for reimbursement.

D–F

Deductible

The portion of the bill a patient must pay before their insurance plan covers costs.

Downcoding

A claim submitted with a lower-level CPT code than appropriate, often resulting in lost reimbursement.

Explanation of Benefits (EOB)

A statement from a payor explaining what was billed, what was covered, and what the patient owes.

Facility Fee

A charge billed by the imaging center or hospital for the use of space and equipment, separate from the radiologist’s fee.

G–I

Geographic Practice Cost Index (GPCI)

Attempt to adjust for cost of living, practice costs, variations in malpractice cost and wages by location.

Global Fee

A single payment covering both the technical and professional components of a radiology service.

Global Period

The time during which all services related to a procedure (e.g., post-op imaging for interventional radiology) are considered included in the payment.

HCPCS (Healthcare Common Procedure Coding System)

A set of standardized codes used alongside CPT codes, especially for Medicare billing.

IMG (Independent Medical Group)

A physician-owned practice or entity that provides professional radiology services independent of a hospital or health system.

Interventional Radiology (IR)

A radiology subspecialty that performs image-guided procedures. Often involves more complex billing due to E/M services, sedation, and device use.

M–P

MAC (Medicare Administrative Contractor)

A private company contracted by CMS to process Medicare claims, set local coverage policies, and audit radiology billing.

Modifier

A two-character code appended to a CPT code to provide additional billing context (e.g., -26 for professional component, -TC for technical component).

MPFS (Medicare Physician Fee Schedule)

CMS’s list of fees assigned to CPT codes based on RVUs and other factors.

MRI (Magnetic Resonance Imaging)

A common radiology procedure with specific CPT codes that often require prior authorization.

NCCI Edits (National Correct Coding Initiative)

CMS rules that determine which procedures can or cannot be billed together.

Payor Mix

The percentage breakdown of a practice’s revenue by insurance type (e.g., Medicare, Medicaid, commercial, self-pay). Influences overall reimbursement rates and financial planning.

P–R

Precertification / Prior Authorization

Approval from a payor required before specific imaging exams are performed; denial may lead to non-payment.

Professional Component (PC)

The portion of a radiology service provided by the interpreting physician (e.g., reviewing images, writing the report).

Practice Expense RVU

The component of an RVU reflecting costs of non-physician resources (equipment, techs, supplies).

RBRVS (Resource-Based Relative Value Scale)

A system used by Medicare to determine physician payment based on work RVU, practice expense, and malpractice RVU.

Revenue Cycle Management (RCM)

The full process of billing, coding, collections, and claim follow-up from patient registration to payment.

RVU (Relative Value Unit)

A unit measuring the value of medical services for reimbursement. Composed of work RVUs, practice expense, and malpractice components.

S–Z

Self-Pay

When a patient pays directly for services without insurance. Typically involves discounted or prompt-pay rates.

Split Billing

Separating the global fee into professional and technical components, often necessary when billing across different entities.

Teleradiology

Remote interpretation of imaging studies. Billing varies depending on licensure, location, and global vs. component-based arrangements.

Technical Component (TC)

The portion of a radiology service covering equipment, image acquisition, and staff support.

Unbundling

Incorrectly billing separate procedures that should be grouped under a single bundled code. This can trigger audits.

wRVU (Work Relative Value Unit)

Reflects the time, skill, training, and intensity required by the physician to perform a procedure. A key component of physician compensation models.