Imaging reimbursement splits into professional and technical components — and every dollar depends on how the contract is structured. Fulcrum Health Partners advises radiology groups and freestanding imaging centers on payer negotiations, professional/technical contracting, and IDR strategy when high-stakes negotiations break down on No Surprises Act claims.
Every imaging service pays in two parts — the professional read and the technical service — and each is negotiated differently.
Freestanding centers often earn the larger technical component; hospital-based radiologists and teleradiology groups bill the professional component. Whether a contract is global or split, who controls the technical, and how out-of-network claims are handled determine the economics of the entire practice.
Fee-schedule cuts hit the professional read, payers steer studies to lower-cost freestanding sites, and hospital-based radiology remains one of the specialties most exposed to out-of-network disputes under the No Surprises Act. Fulcrum turns each of these into a contract and negotiation strategy.
Figures reflect current CMS methodology and industry sources, 2024–2026.
Split shares vary by modality. Who owns the technical component changes the entire negotiation.
Understanding — and controlling — the professional and technical components is the foundation of imaging contract strategy. Here's how each is billed, who bills it, and why it matters at the table.
The physician's work — interpreting the study and rendering the report. Billed with modifier 26.
The equipment, supplies, technologist, and facility cost of performing the scan. Billed with modifier TC.
Both components billed together when one entity owns the imaging and reads the study — the highest-value structure.
Why it matters in negotiation: a payer may rate the professional and technical components very differently, apply the multiple-procedure reduction to the technical component, or push global services toward split rates. Knowing which components you control — and modeling each — is where leverage is won.
From freestanding centers to advanced modality suites and reading rooms — we understand the economics of every setting.
Advanced MRI suite — high-field imaging under technologist supervision.
CT & reading room
Interventional & imaging-guided suite
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Fulcrum turns your imaging data into executive dashboards — split by professional and technical component. Select a profile to explore a sample view.
Illustrative sample dashboard. Fulcrum builds these from your billing data by CPT, modifier, and modality.
Not a service menu — the payer and component problems that decide imaging margin, and the negotiation, contracting, and IDR capabilities that resolve them.
Imaging is a volume business where a few rate points move the whole enterprise. We build the strategy, positioning, and leverage to secure durable commercial terms across every payer.
We structure the component strategy that fits your model — global, PC-only, or TC-only — and defend it against payer reclassification.
CPT-, modifier-, and modality-level modeling that shows exactly what every payer pays for each component.
When a payer won't come to terms, radiology's out-of-network claims move to federal arbitration. We lead a disciplined, evidence-based IDR strategy.
We ensure contractual entitlement becomes realized revenue — surfacing underpayments, modifier errors, and leakage across both components.
As imaging shifts to freestanding settings and platforms consolidate, we align growth and site-of-care strategy with reimbursement reality.
Radiology is one of the specialties most affected by the No Surprises Act. When a payer refuses fair in-network terms, the Independent Dispute Resolution process becomes leverage — if you approach it with discipline and evidence. Fulcrum leads every step.
Structure and pursue the 30-day open-negotiation window with a data-backed position before arbitration.
Scrutinize the payer's Qualifying Payment Amount and identify where it understates fair value.
Build the evidence — training, complexity, market rates — that supports your offer in IDR.
Batch eligible claims and set the offer strategy that maximizes expected recovery.
Model the recovery at stake in your NSA-eligible out-of-network imaging claims.
Directional estimate for discussion only; not legal advice or a guarantee of IDR outcomes. A Fulcrum analysis models your actual QPAs, claims, and eligibility.
Independent by design and fluent in imaging economics — professional and technical components, global contracting, and the No Surprises Act.
No networks, no downstream fees — only your economics.
Component-level fluency that anchors every negotiation.
Disciplined arbitration strategy when talks break down.
Modeling by CPT, modifier, and modality.
Insight into imaging payer behavior in every market.
Site-of-care and platform-grade reimbursement.
Quantified analysis behind every recommendation.
Dashboards and intelligence that clarify the path.
Anonymized outcomes from Fulcrum engagements with radiology groups and imaging centers.
Component-level benchmarking exposed below-market technical rates and built the case that raised them.
A disciplined IDR strategy on NSA-eligible claims recovered millions after a payer refused fair in-network terms.
Harmonized professional and technical contracting across a multi-site platform for a durable rate improvement.
Executive briefings on the forces moving imaging reimbursement — component economics, payer negotiation, site-of-care, and the No Surprises Act.
Whether you're negotiating global or split-component rates, defending the technical component, or pursuing IDR on out-of-network claims, Fulcrum Health Partners delivers the reimbursement expertise radiology and imaging leaders rely on.