Radiology Billing Services in New Mexico

The professional/technical split governs every imaging dollar, and teleradiology makes it sharper. When your physician interprets a study acquired at a facility your group does not own, you bill the professional component with modifier 26; the acquiring site bills the technical component with TC; and only when one entity owns the equipment and performs the read does the global service apply. Under Novitas Jurisdiction H editing, mismatched splits bundle or duplicate. Codes below are shown only for reference.

Advanced imaging adds a prior-authorization layer. CT, MRI, PET, and nuclear studies route through each Turquoise Care plan's radiology benefit manager, and the request must carry the correct CPT, the ordering diagnosis, and the site of service. Contrast studies raise the stakes further, because supervision-and-interpretation and contrast HCPCS units bundle if a professional coder does not sequence them. We confirm the auth and the contrast coding before the study, not after the remittance.

Imaging practice models differ across the state, and our workflows follow them. A hospital-based group in Albuquerque bills professional-component reads at scale and depends on clean 26 modifiers and Novitas documentation. A freestanding imaging center in Rio Rancho or Las Cruces bills technical components and fights hardest over prior auth and contrast units. A teleradiology network covering rural southern and eastern New Mexico from a central reading room needs place-of-service and rendering-provider logic that holds up under both Medicare and Turquoise Care audits. An interventional radiology practice adds procedural, sedation, and supervision coding that NCCI bundles when sequenced wrong.

We build the fee schedule, edits, and appeal templates around your model, so one recurring error does not repeat across a whole panel of members. That is why groups outsource this work: coordinating four MCOs, a brand-new state program, and Medicare rules across hundreds of miles is a discipline of its own, and it competes directly with reading studies when it lives in-house.

We serve hospital-based radiology groups, freestanding imaging and diagnostic centers, interventional radiology practices, teleradiology networks, and multispecialty clinics with imaging lines. Our clients read across the Albuquerque-Rio Rancho metro, the Santa Fe capital region, the Las Cruces border market, and rural sites in the southeast that rely on remote coverage. We also work with mobile imaging providers and critical-access hospital outpatient departments, where facility and professional billing overlap and the split-claim logic is easiest to misapply. However far your reads travel, the billing company behind them should understand New Mexico's four Turquoise Care plans as well as its map, and should treat every remote read as a routing decision before it becomes a coding one.