MRI and CT Scan Billing Errors: What Patients Should Know

MRI and CT scans are among the most expensive routine diagnostic tests in medicine. A brain MRI at a hospital can cost $2,000 to $5,000. A CT scan of the abdomen runs $1,500 to $4,000. These prices vary wildly by facility -- the same MRI that costs $3,500 at a hospital-owned imaging center might cost $500 at a freestanding imaging center across the street.

The billing complexity makes imaging a fertile ground for errors. Every scan generates at least two charges (facility and professional), uses specific CPT codes that vary by body part, contrast use, and number of sequences, and often requires prior authorization that may or may not have been obtained. If any of these components is coded wrong, you pay more than you should.

How imaging billing works

Every MRI or CT scan generates two distinct billing components:

• The technical component (TC) -- covers the equipment, the technologist who operates the scanner, the imaging facility, and supplies like contrast dye. This is the facility charge, indicated by modifier -TC on the CPT code or billed by the hospital as a facility fee.
• The professional component (PC) -- covers the radiologist who reads the images and writes the report. This is indicated by modifier -26 on the CPT code.

When both components are performed and billed by the same entity (for example, a freestanding imaging center that employs its own radiologists), it is billed as a "global" service -- one CPT code, no modifier. When the facility and the radiologist are separate (which is common at hospitals), you receive two bills, each with the appropriate modifier.

Understanding this split is the key to catching most imaging billing errors.

Facility fee vs. professional fee confusion

The most common imaging billing error is confusion or duplication between the facility and professional components.

What to watch for:

• Global billing from a hospital. If a hospital bills the full global CPT code (no modifier) while a separate radiology group also bills the professional component (-26 modifier), you are being double-billed for the professional read. The hospital should bill only the technical component (-TC).
• Missing professional fee. If you only received a facility bill, the radiologist's professional fee may arrive separately weeks later. This is not an error, but it means the total cost of your scan is higher than the first bill suggested. Ask the facility at the time of service who the reading radiologist is and whether you will receive a separate bill.
• Duplicate facility charges. If you had one MRI, you should see one technical component charge. Some hospital billing systems generate a facility charge under a revenue code (e.g., 0610-0619 for MRI) plus a separate CPT code with the -TC modifier -- this should result in one charge, not two.

Use our CPT/HCPCS lookup tool to check the Medicare rate for any imaging code. The tool shows rates for both the technical and professional components separately, which helps you understand what each part should cost.

Contrast vs. no-contrast code errors

This is a high-dollar error category. MRI and CT codes are divided into three variants: without contrast, with contrast, and with and without contrast. The codes and prices are significantly different.

Brain MRI example:

• 70551 -- MRI brain without contrast. Medicare rate: approximately $200 (professional + technical).
• 70552 -- MRI brain with contrast. Medicare rate: approximately $250.
• 70553 -- MRI brain without contrast followed by with contrast. Medicare rate: approximately $310.

Abdomen CT example:

• 74150 -- CT abdomen without contrast. Medicare rate: approximately $145.
• 74160 -- CT abdomen with contrast. Medicare rate: approximately $175.
• 74178 -- CT abdomen and pelvis with and without contrast. Medicare rate: approximately $260.

Common errors:

• Billing "with and without" when only one was performed. A 70553 (brain MRI with and without contrast) costs more than a 70551 (without contrast alone). If you had a simple MRI with no contrast injection, the bill should show 70551, not 70553.
• Billing "with contrast" when no contrast was used. Did you receive an IV injection during the scan? Were you asked about kidney function or allergies before contrast? If not, the scan was likely performed without contrast, and a "with contrast" code is an upcoding error.
• Billing two separate scans instead of the combined code. A "with and without contrast" CT is one study, not two. If your bill shows both 74150 (without) and 74160 (with) instead of the single combined code 74178, this is a common unbundling error that inflates the total.

The simplest way to verify: did you receive a contrast injection (IV or oral)? If you did not receive any injection or drink during the scan, you had a "without contrast" study. If you did, check whether it was a single contrast study or a two-phase (with and without) study. Your scan order from the referring physician will specify this.

Wrong body part coded

MRI and CT codes are body-part specific. Every body region has its own set of codes. If the wrong body part is coded, the price may be different and, more importantly, your insurance may deny the claim because the body part does not match the diagnosis.

Examples of body-part-specific MRI codes:

• 70551-70553 -- Brain
• 70540-70543 -- Orbit, face, neck
• 72141-72158 -- Spine (cervical, thoracic, lumbar -- each has separate codes)
• 73221-73223 -- Upper extremity joint (shoulder, elbow, wrist)
• 73721-73723 -- Lower extremity joint (hip, knee, ankle)
• 74181-74183 -- Abdomen

How this error occurs: A coder selects the wrong body region from a dropdown menu. A knee MRI is coded as a hip MRI. A cervical spine CT is coded as a thoracic spine CT. The prices may be similar, but the mismatch between the code and the diagnosis can trigger a claim denial, leaving you with the full bill.

How to catch it: Compare the body part listed in the CPT code description on your bill to the body part your doctor ordered the scan for. Check the referral or order from your physician -- it should specify exactly which body part and whether contrast is required.

Upcoding to with-contrast when none was used

This deserves its own section because it is both common and costly. The "with contrast" version of any imaging study costs 15-30% more than the "without contrast" version. Some facilities routinely code "with and without contrast" for studies that were performed without contrast, whether through sloppy coding or deliberate upcoding.

How to verify:

1. Check your memory. Did the technologist inject anything into your IV before or during the scan? Did you drink a chalky oral contrast solution before a CT? If neither happened, you had a without-contrast study.
2. Check the radiology report. Request the radiologist's report for your scan. It will explicitly state whether contrast was administered, the type and volume of contrast used, and whether the study was performed with, without, or with and without contrast.
3. Check for contrast supply charges. If contrast was administered, there should be a separate supply charge for the contrast agent (gadolinium for MRI, iodinated contrast for CT). If the CPT code says "with contrast" but there is no contrast supply charge, one of the two is wrong.

Duplicate reads billed

Every imaging study is read (interpreted) by a radiologist, who produces a written report. This generates one professional component charge. Errors occur when the read is billed more than once.

How duplicate reads happen:

• Preliminary and final reads billed separately. In hospital settings, a resident or fellow may perform a preliminary interpretation, followed by a final read by an attending radiologist. Only the final interpretation should be billed. If both appear on your bill, the preliminary read is a duplicate.
• ER read and subsequent read. If you had an imaging study in the ER, the emergency physician may have reviewed the images, followed by a formal read by a radiologist the next day. Only the radiologist's formal interpretation should generate a professional component charge for the imaging code. The ER physician's review is part of their ER E/M service.
• Multiple radiologists billing for the same study. This can happen when a case is transferred between radiologists, or when a subspecialist provides a second opinion on a complex case. Unless a formal second opinion was specifically ordered, only one professional read should be billed.

Prior authorization denied but billed anyway

Many insurance plans require prior authorization for MRI and CT scans. If the authorization is denied and the scan is performed anyway, the insurer will deny the claim, and you may be stuck with the full bill.

What to know:

• The facility should verify authorization before performing the scan. If they did not, and the claim is denied, the billing error is on the facility, not you. You should not be held responsible for a charge that the facility failed to pre-authorize.
• Check your EOB. If the denial reason code on your EOB says "prior authorization not obtained" or "not medically necessary," contact the facility's billing department and ask them to obtain authorization retroactively or appeal the denial.
• Know the difference between "not authorized" and "not covered." If your plan simply does not cover the type of scan ordered, that is a coverage issue, not an authorization issue. But if the plan covers the scan and the facility failed to obtain the required authorization, the facility bears responsibility.

Under many state laws and some insurer policies, if a provider fails to obtain required prior authorization, the provider cannot bill the patient for the denied claim. Check your state's billing rights.

Hospital vs. freestanding imaging center prices

This is not a billing error in the traditional sense, but it is one of the most impactful cost factors for imaging patients to understand. The same MRI, performed on the same type of machine, read by the same quality of radiologist, can cost dramatically different amounts depending on where it is performed.

Typical price ranges:

• Hospital outpatient department: $1,500-$5,000 for an MRI, $1,200-$4,000 for a CT scan. Includes both a facility fee and a professional fee, and may include hospital overhead markup.
• Freestanding imaging center: $400-$1,200 for an MRI, $300-$900 for a CT scan. Typically bills a global fee that includes both technical and professional components.

The difference is often 3-5x. For the same knee MRI, a hospital might charge $3,000 while an independent imaging center charges $600. Both produce clinically equivalent results.

Why it matters for billing disputes: If you were not informed that the imaging center was hospital-owned (and therefore subject to hospital pricing), you may have grounds to dispute the facility fee component, especially if a lower-cost alternative was available in your area. Some states require price transparency for imaging services.

How to check your imaging bill

1. Get the itemized bill and the radiology report. Request both from the imaging facility. The itemized bill shows the CPT code, modifiers, and charges. The radiology report shows what was actually done -- the body part, whether contrast was used, and the findings.
2. Match the CPT code to the study performed. Verify that the body part and contrast status on the CPT code match the radiology report. Use our CPT lookup tool to confirm the code description.
3. Check for proper component billing. If you received separate facility and radiologist bills, make sure one uses the -TC modifier and the other uses the -26 modifier. If either bills the global code (no modifier), you may be double-billed for part of the service.
4. Verify contrast charges match. If the CPT code says "with contrast," there should be a separate contrast supply charge. If there is no contrast charge, the study may have been miscoded. Conversely, if there is a contrast charge but the CPT code says "without contrast," one of the two is wrong.
5. Check for duplicate reads. You should see only one professional component charge (-26 modifier) per imaging study. If you see two, dispute the duplicate.
6. Verify authorization. Check your EOB for any denial related to prior authorization. If the facility did not obtain required authorization, they should not bill you for the denied amount.
7. Run the math. Use our bill math checker to verify the totals add up correctly.

What to do when you find an error

1. Document the discrepancy. Note the CPT code on the bill versus what the radiology report says. Screenshot or print both documents.
2. Call the imaging facility's billing department. Start here for coding errors (wrong body part, wrong contrast status). Most facilities will correct obvious coding mismatches quickly.
3. Call the radiology group. For professional component errors (duplicate reads, wrong modifier), contact the radiology billing office separately.
4. Contact your insurer. If a claim was denied for authorization or medical necessity, ask your insurer to guide the appeal process. For coding errors, ask your insurer to flag the claim for review.
5. Send a written dispute. If phone calls do not resolve the issue, send a formal letter. Our dispute letter generator can help.
6. Consider an independent imaging center. For future scans, ask your doctor if a freestanding imaging center is an option. The quality is equivalent and the price is typically 60-80% lower.

For more background on medical billing errors and how to dispute them, see our step-by-step bill checking guide and our complete guide to medical billing errors. If your insurer denied the imaging claim, our insurance billing errors guide covers the appeal process. For state-specific billing protections, check our state rights guide.

Disclaimer: This guide is for educational purposes only and does not constitute legal, financial, or medical advice. Imaging costs and billing practices vary by facility, location, and insurance plan. Medicare rates cited are approximate national averages and may differ by geographic area. Consult a licensed professional for advice specific to your circumstances.