Skip to content

DATA SERVICES

Portable x-ray billing review

Your transport and set-up billing, checked trip by trip against the Medicare rules.

Ask for the free benchmarkTalk about a review

What the review checks

1. The transport fee split

Medicare pays one transport fee for each trip to a location. When more than one patient is x-rayed there, the fee is split across every patient seen on that trip, whatever their payer.

R0070 is for a trip with one patient. R0075 carries a modifier for the number of patients served: UN for two, UP for three, UQ for four, UR for five and US for six or more. With US the fee is divided by six, however many patients there were.

The review checks each trip in your log against the codes and modifiers billed for it.

Source: Medicare Claims Processing Manual, ch. 13, §90.3.4 (CMS, 2025)

2. Set-up

Q0092 pays a set-up component for each radiologic procedure, other than retakes of the same procedure. It applies on single-patient and multi-patient trips.

The review checks set-up lines against the procedures performed.

Source: Medicare Claims Processing Manual, ch. 13, §90.4 (CMS)

3. Part A nursing home stays

When a resident is in a Medicare-covered Part A stay, the exam's technical component, transport and set-up fall under consolidated billing. They go on the nursing home's Part A bill, not on a Part B claim.

The review checks each Part B claim against the resident's stay dates, where you hold them.

Source: Medicare Claims Processing Manual, ch. 13, §90.3.4 and §90.5 (CMS)

4. The order

Each exam must be ordered by a physician or a nonphysician practitioner. The order must include a statement of the patient’s condition that shows why a portable exam is necessary.

The review checks that every billed exam has an order that meets those rules.

Source: 42 CFR 486.106(a); 42 CFR 410.32(a)

5. Payer status on the date of service

A claim belongs with the payer the patient had on the date of service. Medicare Administrative Contractors process Original Medicare claims. A Medicare Advantage plan processes its own members’ claims. Medicaid is a separate payer again.

The review checks each claim against the patient’s payer status on that date.

Source: CMS MLN fact sheet MLN8659122, Original Medicare vs. Medicare Advantage (July 2026)

What federal reviews have found

The HHS Office of Inspector General has examined claims from portable x-ray suppliers. In a 2017 report on one supplier, 21 of 112 sampled claims did not meet Medicare requirements. The problems were orders, documentation, and transport fees that were not prorated. A 2016 report on another supplier found 29 of 117.

Sources: OIG report A-02-15-01008 (September 2017); OIG report A-02-13-01038 (May 2016).

Those are two suppliers’ samples. They say nothing about your claims.

What we need

  • A trip or dispatch log: date, stop, patients seen and technologist.
  • Claims for the same period, as an 837 export or a billing report.
  • Payments, as 835 remittance files or a payment report.
  • An exam list with the exam, views and ordering practitioner.
  • Part A stay dates for nursing home residents, where you hold them.

Scoping can start from counts alone. Patient-level data comes only after a business associate agreement is signed.

What you get

A findings report. It lists each issue, the claims affected, the dollars at risk and the fix. It also says what could not be checked.

The review has a fixed fee, quoted after a 20-minute call. It is never a percentage of collections.

See a sample review, built on synthetic data with known planted errors.

How we handle your data

Start with the free benchmarkAll data services