A Quick Guide to Modifiers 26 and TC

modifiersOccasionally, the total service/procedure described by a single CPT® code is comprised of two distinct portions: a professional component and a technical component.

The professional component of a diagnostic service/procedure is provided by the physician, and may include supervision, interpretation, and a written report.

The technical component of a diagnostic service/procedure accounts for equipment, supplies, and clinical staff (such as technicians). Payment for the technical component also includes the practice expense and the malpractice expense. Fees for the technical component generally are reimbursed to the facility or practice that provides or pays for the equipment, supplies, and/or clinical staff.

Procedures/services that may include both a professional and technical component are found commonly within the “Radiology,” “Pathology and Laboratory,” and “Medicine” sections of the CPT® codebook.

Separate payment may be made for the technical and professional components of a procedure if, for example, a clinic provides the technical component of a service/procedure, while an individual physician performs the professional component. In such situations, each provider must submit a claim and bill only for the service performed.

To identify professional services only for a service/procedure that includes both professional and technical components, append modifier 26 Professional component to the appropriate CPT® code, as instructed in CPT® Appendix A (“Modifiers”). Note that modifier 26 is appropriate when the physician supervises and/or interprets a diagnostic test, even if he or she does not perform the test personally. Do not append modifier 26 if there is a dedicated code to describe only the professional/physician component of a given service (e.g., 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only).

Appending modifier TC Technical component indicates that only the technical component of a service/procedure has been provided. Generally, the technical component of a service/procedure is billed by the entity that provides the testing equipment.

Physicians providing services for Medicare patients in a hospital or facility setting cannot claim the technical portion of a procedure. Under the diagnosis-related group (DRG), the hospital/facility receives payment for the technical component of Medicare inpatient services. Similarly, Medicare rules require that payment for non-physician services provided to hospital patients (such as the services of a technician administering a diagnostic test) are made to the hospital.

Just as there are codes that describe professional-only services for Medicare, so are there codes describing technical component-only services (e.g., 93005 Electrocardiogram; tracing only, without interpretation and report).

A “global” service includes both the professional and technical components of a single service. When reporting a global service, no modifiers are necessary to receive payment for both components of the service.

For example: Code 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete includes both a technical component (the ultrasound machine, along with necessary supplies and clinical staff to support its use) and a professional component (physician supervision, interpretation, and report). If pelvic ultrasound is performed at the physician’s office, either by a physician or a technician employed by the practice, report 76856 without a modifier because the practice provided both components of the service.

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