Radiology pros and billing teams—ever dealt with a stack of denied claims for telehealth-related radiology services? Then you know how much it can slow down your practice. Whether it's remote consultations or interpretations tied to virtual visits, getting hit with denials on codes like those for imaging guidance or inpatient follow-ups is all too common. As we roll through 2025, CMS has kept some flexibilities in place, but rules around place of service, modifiers, and eligibility are key to avoiding those frustrating rejections. We'll walk through common pitfalls and straightforward fixes, based on the latest from CMS, so you can get paid faster and focus on patient care.

Common Reasons for Telehealth Denials in Radiology Billing

Radiology doesn't always fit neatly into telehealth—most diagnostic imaging codes aren't on the Medicare telehealth services list because they don't require real-time interaction. But when telehealth comes into play, like for remote consultations or when radiology ties into a virtual E/M service, denials often crop up from a few repeat offenders.

One big issue is place of service (POS) errors. If you're billing for a telehealth service where the patient is at home, use POS 10 to get the non-facility rate—using POS 02 by mistake can trigger a denial. CMS updated this in 2024, and it's sticking around in 2025, but old habits die hard, especially if your system hasn't been updated.

Another frequent culprit is missing or wrong modifiers. For synchronous telehealth (real-time audio-video), add modifier 95 to eligible codes. Without it, claims get kicked back. And for radiology-specific scenarios, like follow-up inpatient consultations via telehealth, codes like G0406-G0408 need to be spot-on, or you'll see denials for non-covered services.

Documentation gaps also lead to trouble, especially for medical necessity. If the record doesn't clearly show why the telehealth component was needed—like symptoms justifying a remote imaging consult—payers may deny for lack of support. Prior authorization is another gotcha; some high-cost imaging linked to telehealth might require it, and skipping that step is a quick path to rejection.

Lastly, eligibility checks fall short sometimes. If the patient's coverage doesn't include telehealth for that service, or if you're not an eligible distant site provider, the claim won't fly. Through September 30, 2025, more providers can bill as distant sites, but post that, restrictions tighten up.

How to Fix These Errors and Prevent Future Denials

The good news? Most of these are fixable with a few tweaks to your process. Start by auditing denied claims to spot patterns—CMS recommends tracking them to identify trends.

For POS mix-ups, double-check the patient's location during the service. If it's home, go with POS 10; otherwise, POS 02. Update your EHR templates to prompt for this, and resubmit corrected claims promptly.

On modifiers, make sure 95 is appended for interactive services, and review the NCCI manual to avoid bundling issues with radiology guidance codes. If you're using G codes for telehealth consultations, confirm they're appropriate for the scenario—inpatient follow-up, not outpatient reads.

Boost documentation by including clear rationale for telehealth use, like patient barriers to in-person visits or specific symptoms. For medical necessity, link the service to the diagnosis code tightly. And always verify prior auth requirements upfront through your payer portals.

For eligibility, run real-time checks before the visit. CMS allows all eligible providers to furnish distant site services through 2025, but confirm your status. If a denial hits, appeal with supporting docs—many get overturned if the error was simple.

What This Means for Your Radiology Practice

In radiology, where remote interpretations are common, blending telehealth can expand access but amps up billing complexity. Getting these right means fewer write-offs, better cash flow, and less admin hassle. With CMS extending some flexibilities—like no geographic limits through September 30, 2025—you've got room to grow virtual services, but only if claims go through clean.

If you're seeing persistent denials, tools for automated eligibility verification and claim scrubbing can make a difference. At Athelas, we help radiology groups simplify billing with tech that flags errors before submission and handles appeals efficiently. Drop us a line if you want to chat about optimizing your setup.