Specialties / Imaging and medical supplies
Imaging and supply billing, done for you
We code every study and every piece of equipment, check the order, modifiers and proof of delivery, and follow each claim until it is paid. You keep your EMR and see every claim live.
Live for imaging and medical supply billing.
The rules we code and check before an imaging or supply claim goes out
| Rule | What it means | What we check | Who decides |
|---|---|---|---|
| Professional and technical components | Most imaging codes split into the reading (modifier 26) and the equipment, staff and supplies (TC). A practice that owns the machine and reads the study bills the code with no modifier, the global service. For a hospital patient, Medicare pays the practice only the reading. | Each code's PC/TC indicator in Medicare's fee schedule file, who owns the equipment and who read the study | Mohenara, from the order, the report and your setup |
| Guidance codes and units | Needle guidance (76942, 77002, 77003, 77012, 77021) is one unit per encounter, however many needles are placed. | Units per encounter; code pairs against Medicare's quarterly edit file | Mohenara codes from the report |
| Appropriate use criteria | Medicare paused the program and rescinded its rules from January 1, 2024. Medicare claims no longer carry AUC consultation information. | No AUC codes on Medicare claims | Mohenara |
| Authorizations for advanced imaging | Most UnitedHealthcare commercial plans, for example, require authorization for CT, MRI, MRA, PET and nuclear cardiology in the office. The ordering office requests it; the practice doing the scan must confirm it exists first. Without it the claim can be denied and the patient cannot be billed. | Authorization number on the claim; scan inside the approved codes and dates | The ordering office or your front desk requests it; Mohenara tracks it |
| Written order for equipment | Every equipment item needs a written order with the patient, the item, the quantity, the order date and the practitioner's name or NPI and signature, before the claim is sent. Items on CMS's required list need the order before delivery and a face-to-face visit in the 6 months before it. | Every order element present, and the order and visit dates, before the claim goes out | The treating practitioner writes and signs the order; Mohenara checks it |
| Equipment modifiers | RR for a rental, NU for a new purchase, UE for a used one. KX says the policy's coverage requirements are met and documented. Pricing modifiers go first and KX second; an item for each side goes on two lines, RT and LT. | The HCPCS code and modifiers for each item, and the documentation behind KX | Mohenara adds KX only when the records meet the policy |
| Capped rental | Capped rental items are paid monthly for up to 13 continuous months. After the 13th paid month, the supplier transfers title to the patient. | The rental month on every claim, and the 13-month count per patient and item | Mohenara |
| Proof of delivery | The date of service is the delivery date, or the shipping date when a shipping service delivers. Proof of delivery is kept for 7 years; items without it are denied in review. | A signed delivery record or shipping proof before the claim goes out, with the matching date of service | Your staff record the delivery; Mohenara checks it |
Medicare updates code-pair edits each quarter and PC/TC indicators and fees each January.
Before the scan or delivery
Software
Automated check
- Coverage active, plan dates, copay, coinsurance and deductible, as the insurance company returns them.
- An answer the payer leaves incomplete stays unknown, never zero.
Software
Tracking
- Authorizations for CT, MRI and PET, with approved codes and dates.
- The rental month of every capped rental item.
You
Your front desk
- Confirms the authorization before the scan.
- Keeps the written order and the delivery record with the patient's file.
- Gets Advance Beneficiary Notices (ABNs) signed when needed.
- Collects copays.
A coverage check is not a guarantee of payment.
What you see
Every claim, live. Billed, paid, owed and for how long, by payer.
Your dashboard, Money.See the live dashboard
Get a billing plan for your practice
Your price at 3.5% of what we collect, worked on your numbers.