TL;DR
Chapter 13 of the Medicare Claims Processing Manual covers billing for radiology and other diagnostic tests. It explains the split between the professional and technical components, the billing rules for CT, MRI and nuclear medicine, the long history of PET coverage and billing requirements, radiation oncology treatment management, portable x-ray suppliers, bone mass measurements and how to choose the place of service when the interpretation and the test happen in different places.
Chapter 13 at a glance
- Current revision
- Rev. 13150
- Issued April 11, 2025
- Effective
- January 1, 2025
- Implemented May 12, 2025
- Sections
- 88
- 15 top-level sections
- Transmittals in history
- 47
- Listed at the end of the chapter
- Monthly searches
- 50
- Google Ads, US, October 2026
What chapter 13 governs for billing
Most diagnostic tests have two parts: the technical component, which is the equipment, staff and supplies, and the professional component, which is the physician's interpretation. Section 20 explains how the two are paid and billed, separately with modifiers TC and 26 or together as a global service when one entity furnishes both. Sections 30 and 40 cover CT and MRI, including low osmolar contrast media and magnetic resonance angiography, and section 50 covers nuclear medicine, radionuclides, stressing agents and the multiple procedure policy.
Section 60 is the largest part of the chapter and documents PET scan billing across many national coverage decisions: the qualifying conditions, the HCPCS code chart, the cancer, dementia and cardiac indications, the coverage with evidence development and clinical trial claims, and the billing of noncovered indications. Section 70 covers radiation oncology, including weekly treatment management and the services bundled into it, and section 80 covers supervision and interpretation codes and interventional radiology.
The later sections deal with settings: portable x-ray suppliers and their transportation and set-up components (90), interpretations of tests furnished to emergency room patients (100), institutional claims (110 and 120), bone mass measurements and their frequency limits (140), and the place of service rule in section 150. That rule says the physician who bills the professional component reports the place of service where the beneficiary received the technical component, so an interpretation read from an office for an MRI done on a hospital campus is billed with the on-campus outpatient hospital code.
Sections billing teams use most
Section numbers and headings are CMS's; the notes are ours. Each section number opens the official chapter 13 PDF at the page where that section starts.
| Section | CMS heading | Why it matters |
|---|---|---|
| 20.1 | Professional Component (PC) | Professional component billing and the role of modifier 26. |
| 20.2 | Technical Component (TC) | Technical component billing and the role of modifier TC. |
| 60.3 | PET Scan Qualifying Conditions and HCPCS Code Chart | PET scan qualifying conditions and the HCPCS code chart. |
| 60.12 | Coverage for PET Scans for Dementia and Neurodegenerative Diseases | PET for dementia and neurodegenerative diseases, updated with the beta amyloid PET coverage change. |
| 70.2 | Services Bundled Into Treatment Management Codes | Services bundled into radiation therapy treatment management codes. |
| 90.3 | Transportation Component (HCPCS Codes R0070 - R0075) | Portable x-ray transportation component billing. |
| 150 | Place of Service (POS) Instructions for the Professional Component (PC or Interpretation) and the Technical Component (TC) of Diagnostic Tests | Place of service for the professional and technical components when they are furnished in different settings. |
How chapter 13 shows up on claims and denials
Component mix-ups are the most common chapter 13 problem. A modifier 26 or TC that does not fit the code returns reason code 4, and billing the global service for a test whose technical component the hospital already billed leads to a denial or a recoupment of the technical portion. Multiple imaging procedures in the same session take the multiple procedure payment reduction, which posts as reason code 59 and is a payment adjustment, not an error.
PET and other tests governed by a national coverage determination deny with reason code 50 when the diagnosis does not meet the policy, and remark code N386 points to the NCD. Before appealing, compare the documented indication with the NCD and the PET code chart in section 60, and check whether the claim needed a clinical trial or coverage with evidence development modifier.
Codes you are likely to see on the remittance when a claim runs into this chapter's rules. The code pages explain each code's meaning, root causes and the usual fix.
| Code | Type | When it appears |
|---|---|---|
| 4 | Claim adjustment reason code | Modifier 26 or TC inconsistent with the procedure code. |
| 59 | Claim adjustment reason code | Payment reduced under multiple procedure rules. |
| 50 | Claim adjustment reason code | Test not medically necessary for the diagnosis billed. |
| N386 | Remark code | Decision based on a National Coverage Determination. |
Current revision and recent transmittals
The chapter PDF posted on cms.gov is current through Rev. 13150, issued April 11, 2025, effective January 1, 2025, implemented May 12, 2025 (change request 13909). That revision changed sections 90.3 (Transportation Component (HCPCS Codes R0070 - R0075)), 90.3.1 (Periodic Review), 90.3.2 (Annual Update), 90.3.3 (Publishing Payment Rates), 90.3.4 (Modifiers for Single and Multiple Patients Served at the Same Location). Its subject line reads: “Internet Only Manual (IOM) Update to 100-04 Chapter 13, Section 90.3 - Transportation Component (HCPCS Codes R0070 - R0075) and Chapter 23, Section 30.5 - Payment Amounts for Portable X-Ray Transportation Services”.
The newest rows of the transmittal history printed at the end of the chapter (47 revisions in all). Rows whose subject could not be read reliably from the PDF table are left out; the PDF has the complete list.
| Revision | Issued | Subject | CR |
|---|---|---|---|
| R13150CP | April 11, 2025 | Internet Only Manual (IOM) Update to 100-04 Chapter 13, Section 90.3 - Transportation Component (HCPCS Codes R0070 - R0075) and Chapter 23, Section 30.5 - Payment Amounts for Portable X-Ray Transportation Services | 13909 |
| R12364CP | November 16, 2023 | NCD 220.6.20 - Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease | 13429 |
| R11021CP | October 1, 2021 | Revisions To Chapters 13, 18 And 32 To Update Coding | 12376 |
| R10881CP | August 6, 2021 | REVISIONS TO CHAPTERS 13 AND 32 TO UPDATE CODING | 12069 |
| R4267CP | March 27, 2019 | Evaluation and Management (E/M) when Performed with Superficial Radiation Treatment | 11137 |
| R4150CP | October 26, 2018 | Update to Bone Mass Measurements (BMM) Code 77085 Deductible and Coinsurance | 10956 |
Sections ordered by the date in the revision note printed under each heading.
| Section | Heading | Revision |
|---|---|---|
| 90.3 | Transportation Component (HCPCS Codes R0070 - R0075) | Rev. 13150, April 11, 2025; effective January 1, 2025 |
| 90.3.1 | Periodic Review | Rev. 13150, April 11, 2025; effective January 1, 2025 |
| 90.3.2 | Annual Update | Rev. 13150, April 11, 2025; effective January 1, 2025 |
| 90.3.3 | Publishing Payment Rates | Rev. 13150, April 11, 2025; effective January 1, 2025 |
| 90.3.4 | Modifiers for Single and Multiple Patients Served at the Same Location | Rev. 13150, April 11, 2025; effective January 1, 2025 |
| 60.12 | Coverage for PET Scans for Dementia and Neurodegenerative Diseases | Rev. 12364, November 16, 2023; effective October 13, 2023 |
| 60.3.1 | Appropriate CPT Codes Effective for PET Scans for Services Performed on or After January 28, 2005 | Rev. 10881, August 6, 2021; effective September 7, 2021 |
| 60.3.2 | Tracer Codes Required for Positron Emission Tomography (PET) Scans | Rev. 10881, August 6, 2021; effective September 7, 2021 |
Section index
Every section in the chapter's table of contents, grouped under its top-level heading, with the PDF page where it starts. Open a heading to see its subsections.
10 ICD Coding for Diagnostic Tests · p. 4 · 1 subsections
- Open section 10 in the PDF
- 10.1 Billing Part B Radiology Services and Other Diagnostic Procedures · p. 4
20 Payment Conditions for Radiology Services · p. 4 · 9 subsections
- Open section 20 in the PDF
- 20.1 Professional Component (PC) · p. 4
- 20.2 Technical Component (TC) · p. 4
- 20.2.1 Hospital and Skilled Nursing Facility (SNF) Patients · p. 4
- 20.2.2 Services Not Furnished in Hospitals · p. 5
- 20.2.3 Services Furnished in Leased Departments · p. 5
- 20.2.4 Services That Do Not Meet the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013 · p. 5
- 20.2.5 Special Rule to Incentivize Transition from Traditional X-Ray Imaging to Digital Radiography · p. 6
- 20.2.5.1 Remittance Advice Remark Codes (RARCs), Claim Adjustment Reason Codes (CARCs), and Medicare Summary Notice (MSN) · p. 6
- 20.2.6 Special Rule to Incentivize Transition from X-rays taken using Computed Radiography to Digital Radiography · p. 7
30 Computerized Axial Tomography (CT) Procedures · p. 10 · 5 subsections
- Open section 30 in the PDF
- 30.1 Low Osmolar Contrast Media (LOCM) (HCPCS Codes Q9945-Q9951) · p. 10
- 30.1.1 Payment Criteria · p. 10
- 30.1.2 Payment Level · p. 10
- 30.1.3 SNF Billing and A/B MAC (A) Payment for Contrast Material Other Than Low Osmolar Contrast Material (LOCM) (Radiology) · p. 10
- 30.1.3.1 A/B MAC (A) Payment for Low Osmolar Contrast Material (LOCM) (Radiology) · p. 11
40 Magnetic Resonance Imaging (MRI) Procedures · p. 13 · 6 subsections
- Open section 40 in the PDF
- 40.1 Magnetic Resonance Angiography (MRA) · p. 14
- 40.1.1 Magnetic Resonance Angiography (MRA) Coverage Summary
- 40.1.2 HCPCS Coding Requirements · p. 15
- 40.1.3 Special Billing Instructions for RHCs and FQHCs · p. 16
- 40.1.4 Payment Requirements · p. 16
- 40.2 Medicare Summary Notices (MSN), Reason Codes, and Remark Codes · p. 17
50 Nuclear Medicine (CPT 78000 - 79999) · p. 18 · 6 subsections
- Open section 50 in the PDF
- 50.1 Payments for Radionuclides · p. 18
- 50.2 Stressing Agent · p. 18
- 50.2.1 A/B MAC (A) Payment for IV Persantine · p. 19
- 50.2.2 A/B MAC (A) Payment for Adenosine · p. 19
- 50.3 Application of Multiple Procedure Policy (CPT Modifier "-51") · p. 19
- 50.4 Generation and Interpretation of Automated Data · p. 19
60 Positron Emission Tomography (PET) Scans - General Information · p. 19 · 23 subsections
- Open section 60 in the PDF
- 60.1 Billing Instructions · p. 20
- 60.2 Use of Gamma Camera and Full and Partial Ring PET Scanners for PET Scans · p. 22
- 60.2.1 Coverage for Myocardial Viability · p. 22
- 60.3 PET Scan Qualifying Conditions and HCPCS Code Chart · p. 22
- 60.3.1 Appropriate CPT Codes Effective for PET Scans for Services Performed on or After January 28, 2005 · p. 27
- 60.3.2 Tracer Codes Required for Positron Emission Tomography (PET) Scans · p. 28
- 60.3.3 Denial Messages for Noncovered PET Services · p. 29
- 60.4 PET Scans for Imaging of the Perfusion of the Heart Using Rubidium 82 (Rb 82) · p. 29
- 60.5 Expanded Coverage of PET Scans for Solitary Pulmonary Nodules (SPNs) · p. 30
- 60.6 Expanded Coverage of PET Scans Effective for Services on or After July 1, 1999 · p. 30
- 60.7 Expanded Coverage of PET Scans Effective for Services on or After July 1, 2001 · p. 30
- 60.8 Expanded Coverage of PET Scans for Breast Cancer Effective for Dates of Service on or After October 1, 2002 · p. 31
- 60.9 Coverage of PET Scans for Myocardial Viability · p. 31
- 60.10 Coverage of PET Scans for Thyroid Cancer · p. 32
- 60.11 Coverage of PET Scans for Perfusion of the Heart Using Ammonia N-13 · p. 32
- 60.12 Coverage for PET Scans for Dementia and Neurodegenerative Diseases · p. 33
- 60.13 Billing Requirements for PET Scans for Specific Indications of Cervical Cancer for Services Performed on or After January 28, 2005 · p. 36
- 60.14 Billing Requirements for PET Scans for Non-Covered Indications · p. 36
- 60.15 Billing Requirements for CMS - Approved Clinical Trials and Coverage With Evidence Development Claims for PET Scans for Neurodegenerative Diseases, Previously Specified Cancer Indications, and All Other Cancer Indications Not Previously Specified · p. 36
- 60.16 Billing and Coverage Changes for PET Scans · p. 38
- 60.17 Billing and Coverage for PET Scans for Cervical Cancer Effective for Services on or After November 10, 2009 · p. 41
- 60.18 Billing and Coverage Changes for PET (NaF-18) Scans to Identify Bone Metastasis of Cancer Effective for Claims With Dates of Services on or After February 26, 2010 · p. 42
- 60.19 Local Coverage Determination for PET Using New, Proprietary Radiopharmaceuticals for their FDA-Approved Labeled Indications for Oncologic Imaging Only · p. 44
70 Radiation Oncology (Therapeutic Radiology) · p. 44 · 5 subsections
- Open section 70 in the PDF
- 70.1 Weekly Radiation Therapy Management (CPT 77419 - 77430) · p. 44
- 70.2 Services Bundled Into Treatment Management Codes · p. 45
- 70.3 Radiation Treatment Delivery (CPT 77401 - 77417) · p. 48
- 70.4 Clinical Brachytherapy (CPT Codes 77750 - 77799) · p. 48
- 70.5 Radiation Physics Services (CPT Codes 77300 - 77399) · p. 48
80 Supervision and Interpretation (S&I) Codes and Interventional Radiology · p. 48 · 2 subsections
- Open section 80 in the PDF
- 80.1 Physician Presence · p. 48
- 80.2 Multiple Procedure Reduction · p. 49
90 Services of Portable X-Ray Suppliers · p. 49 · 9 subsections
- Open section 90 in the PDF
- 90.1 Professional Component · p. 49
- 90.2 Technical Component · p. 49
- 90.3 Transportation Component (HCPCS Codes R0070 - R0075) · p. 49
- 90.3.1 Periodic Review · p. 50
- 90.3.2 Annual Update · p. 51
- 90.3.3 Publishing Payment Rates · p. 51
- 90.3.4 Modifiers for Single and Multiple Patients Served at the Same Location · p. 51
- 90.4 Set-Up Component (HCPCS Code Q0092) · p. 53
- 90.5 Transportation of Equipment Billed by a SNF to a MAC · p. 53
100 Interpretation of Diagnostic Tests · p. 54 · 1 subsections
- Open section 100 in the PDF
- 100.1 X-rays and EKGs Furnished to Emergency Room Patients · p. 54
110 Special Billing Instructions for Claims Submitted to A/B MACs (A) · p. 56 · 3 subsections
- Open section 110 in the PDF
- 110.1 Aborted Procedure · p. 56
- 110.2 Combined Procedures (Radiology) · p. 56
- 110.3 Payment for Radiopharmaceuticals
120 Radiology or Other Diagnostic Unlisted Service or Procedure Billing Instructions for A/B MAC (A) Claims · p. 57
130 EMC Formats · p. 59
140 Bone Mass Measurements (BMMs) · p. 59 · 3 subsections
- Open section 140 in the PDF
- 140.1 Payment Methodology and HCPCS Coding · p. 60
- 140.2 Denial Messages for Noncovered Bone Mass Measurements · p. 62
- 140.4 Advance Beneficiary Notices (ABNs) · p. 63
150 Place of Service (POS) Instructions for the Professional Component (PC or Interpretation) and the Technical Component (TC) of Diagnostic Tests · p. 63
Using this chapter in a denial or appeal
Start with the remittance. The claim adjustment reason code says what happened to the line, the remark code narrows it, and the group code says who is liable. Match that to the section of the chapter that sets the rule, then read the section in the official PDF rather than a summary: the wording that matters, such as a time limit, a modifier requirement or a documentation element, is usually a single sentence. Check the revision note under the section heading, because a rule that changed after the date of service may not apply to the claim, and an effective date earlier than the issue date can make a new rule reach back.
When the chapter supports the claim, cite it precisely in the redetermination request: the publication number, chapter, section and revision. When it does not, the fix is usually a corrected claim or better documentation rather than an appeal, and a coding or format rejection is corrected and resubmitted because it carries no appeal rights. Manual instructions bind the Medicare Administrative Contractor, so they settle most first-level disputes; at the hearing level, administrative law judges give them substantial deference without being bound by them. If the issue turns on whether a service is covered at all, read the matching Benefit Policy Manual chapter and any national coverage determination or local coverage determination as well, because coverage and billing rules are written in different places.
How QuickIntell works with Claims Processing Manual chapter 13
QuickRCM covers eligibility, claim readiness, denials, posting and A/R with configurable automation and human review, which is where the billing rules in this chapter are checked before a claim goes out. QuickCode supports qualified coder review of the coding and modifier questions the chapter answers.
Frequently asked questions: chapter 13
What is the difference between modifier 26 and TC?
Chapter 13 section 20 explains that modifier 26 bills only the professional component, the physician's interpretation, and modifier TC bills only the technical component, the equipment, staff and supplies. Without either modifier the claim is for the global service.
Which place of service goes on a remote interpretation?
Section 150 says the physician billing the professional component uses the place of service where the beneficiary received the technical component, not where the physician read the study.
Where are the PET billing rules?
Section 60 of chapter 13 holds the PET billing instructions, the qualifying conditions and HCPCS chart, and the requirements tied to each national coverage determination for PET.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- Medicare Claims Processing Manual, Chapter 13: Radiology Services and Other Diagnostic ProceduresVersion Rev. 13150, issued 2025-04-11 · effective 2025-01-01 · file clm104c13.pdfSHA-256 708f24fcbc2c1bb4…
- Medicare Claims Processing Manual (Pub. 100-04)Version 39 chapter PDFs; newest revision Rev. 13836 (chapter 14), issued 2026-06-24 · effective 2026-09-27 · file 100-04-claims-processing-manual/*.pdf (39 chapters; SHA-256 of their sha256sum listing)SHA-256 f87bc3bcd9d1570d…
Disclaimer
This guide summarizes a CMS manual chapter in our own words for billing teams; section headings and transmittal subjects are quoted from the chapter PDF. The chapter itself is the authority, and it changes by transmittal. Not legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.