Radiology & Imaging · CY2026 Billing Brief

The PC/TC split is tighter in 2026. AUC just went quiet.

Two questions run every radiology claim this year: did you split the professional and technical components correctly, and do you still owe an Appropriate Use Criteria consultation? The answers moved.

Short version: Component discipline is where the money is. Global (no modifier) only pays when you own both the read and the equipment; otherwise it is 26 for the read, TC for the machine. And the AUC / clinical decision support mandate that hung over imaging for a decade is not being enforced for 2026. CMS rescinded the program. No consultation, no G-codes, no modifier on the claim.

Anatomy of one imaging charge

-26Professional

-TCTechnical

GLOBAL = 26 (read) + TC (equipment, staff, supplies)

AUC consultations required, 2026

The PAMA imaging CDS mandate is paused and its regulation rescinded. Ordering providers do not consult a CDSM; furnishing providers report nothing.

The numbers that decide the claim

A stat wall for component-split discipline

Radiology underpayment is rarely exotic. It is the same handful of mechanics, applied wrong, thousands of times. Here is the 2026 landscape in figures you can hold in your head.

Modifiers that split every study

Modifier 26 for the professional read, TC for the technical component. Get one wrong and you either double-bill or leave half the fee on the table.

50%

TC reduction on the second study

Under the Multiple Procedure Payment Reduction, the technical component of each additional advanced imaging service in the same session pays at half.

PC reduction, same session

The professional component of subsequent advanced imaging by the same physician or group takes a 5% cut. Smaller, but it recurs on every multi-study encounter.

Consultations owed in 2026

CMS rescinded the AUC regulation at 42 CFR 414.94. No CDSM lookup, no G-code, no modifier. The decade-long mandate is off the claim.

Field that governs TC eligibility

Place of service. In a facility setting the hospital bills the TC, so a physician who bills global or TC there invites the denial.

Fee schedule sets all three prices

The CY2026 Medicare Physician Fee Schedule final rule prices the global, the 26, and the TC separately. Reconcile your fee master to it, not to last year’s.

Where the split goes wrong

Global, 26, and TC are three different bills

Treat them as one and you will overbill in the hospital and underbill in the office. The test is ownership: who read the image, and who owns the machine that made it.

Global · no modifier

You own both halves

Bill the study clean, with no component modifier, only when one entity furnished the equipment and interpreted the image, typically an independent imaging center or physician office with its own scanner.

Freestanding imaging center reading its own studies
Office with in-house modality and radiologist
Wrong here means: unbundling a global into 26 + TC you did not both earn

Modifier 26

You read it, someone else owns the machine

Append 26 when your physician interprets a study performed on equipment you do not own, the classic hospital-based or teleradiology read. You bill the professional work only.

Radiologist reading hospital-acquired films
Teleradiology night coverage
Wrong here means: billing global in a facility and getting the TC clawed back

Modifier TC

You own the machine, someone else reads

Append TC for the equipment, technologist, and supplies when a different provider interprets. In most facility settings the institution bills the TC and the physician bills only 26.

Imaging center that sends reads to an outside group
Mobile modality vendor
Wrong here means: a physician billing TC in a place of service where the facility already did

What actually happened to AUC

A decade of “almost required,” then rescinded

Appropriate Use Criteria was written into law in 2014 and never once enforced with a payment penalty. Here is the real status heading through 2026, so nobody rebuilds a workflow the program no longer needs.

2014

PAMA creates the AUC program

The Protecting Access to Medicare Act directs that advanced diagnostic imaging orders be checked against Appropriate Use Criteria through a qualified Clinical Decision Support Mechanism.

2020–2021

Educational and operations testing period

Consultation was encouraged and claims carried voluntary AUC codes, but no claim was denied for missing them. The payment-penalty phase kept slipping.

2023

CMS pauses implementation

Facing unresolved operational problems, CMS formally paused the program indefinitely and set no new start date for the mandatory payment phase.

2024 → 2026

Regulation rescinded, and it stays that way CURRENT

The CY2024 MPFS final rule rescinded the AUC regulations at 42 CFR 414.94. Through 2026 there is no consultation requirement, no CDSM lookup, and nothing AUC-related to report on the claim. Any G-codes or modifiers still in your imaging templates are dead weight, remove them.

The one reduction that quietly reshapes multi-study encounters

When several advanced imaging services are furnished to the same patient in the same session, the Multiple Procedure Payment Reduction stacks. Model it before you bill, not after the remit lands.

First study

100%

Highest-valued procedure pays in full on both components.

Each additional · TC

−50%

The technical component of every subsequent advanced imaging service is reduced by half.

Each additional · PC

−5%

The professional component of subsequent studies by the same physician or group is reduced 5%.

// If your expected-reimbursement model still assumes 100% on study two, your AR is aging against a number that was never coming.

Before the batch goes out

The 2026 radiology clean-claim check

Six habits that stop the denials we see most on imaging AR. None of them require new technology, only the discipline to apply the current rules.

1Match the modifier to ownershipGlobal only when you own read and machine. Otherwise 26 or TC, never both from the same billing entity.

2Read place of service firstFacility POS almost always means the physician bills 26 only. Confirm before letting a global or TC through.

3Strip dead AUC codesDelete lingering AUC G-codes and CDSM modifiers from imaging templates. They are not required and only add edit noise.

4Model MPPR on multi-study visitsExpect the 50% TC and 5% PC reductions on additional advanced imaging so the posted payment is not flagged as a shortfall.

5Reprice to the CY2026 MPFSRefresh global, 26, and TC allowables from the CY2026 final rule. Do not carry last year’s fee master forward untouched.

6Watch OPPS/ASC for facility TCHospital-based and ASC imaging technical payments follow OPPS/ASC, not the physician schedule. Reconcile facility lines to the right rule.

2026 guidelines referenced on this page

CY2026 Medicare Physician Fee Schedule (MPFS) final rule — global, professional (26), and technical (TC) component pricing
Professional / technical component modifiers 26 and TC — CMS component-billing policy
Appropriate Use Criteria program status — PAMA 2014; CY2024 MPFS final rule rescinding 42 CFR 414.94; paused through 2026
Multiple Procedure Payment Reduction (MPPR) for advanced diagnostic imaging — 50% technical and 5% professional component reductions
OPPS and ASC final rules — facility technical-component payment for hospital-based and ambulatory surgery imaging

Your imaging AR does not need more software. It needs the split done right.

ASP-RCM Solutions runs radiology and imaging billing where the component discipline, the MPPR modeling, and the current AUC status are baked into the edit set, not left to memory. We reprice to the CY2026 MPFS, retire the dead AUC codes, and reconcile facility technical components to OPPS and ASC so the posted payment matches the expected one.

Book a radiology billing review → See our imaging billing services

// ASP-RCM Solutions · RCM built by operators, for operators