Modifier 26
(Professional) & TC (Technical)
Certain CPT codes have
both the professional (The physician only interpreted the results and gave a
report) and technical (equipment, supplies, technicians and facility)
components of a service.
The professional and
technical components together are referred to as “Global”. (The provider is
reimbursed for the equipment, supplies and technical support as well as the
interpretation of the results and the report).
It’s very important to
know when to bill globally and when to segregate a code into the professional
and technical component.
Only the physician or
professional component is being billed – add modifier 26
Only the technical
component is being billed – add modifier TC
When a service is being
billed globally just bill the appropriate CPT alone without adding 26 or TC.
Eg: A physician sees a
patient in his office for an injured hand. The physician needs hand x-rays of
the patient and taken in his office. The service would be billed as CPT 73130
(radiologic examination of the hand, minimum of 3 views).
In the above scenario it’s billed globally - No modifiers were used with the code 73130
If the x-ray were taken
somewhere other than physician office, such as in a hospital, the hospital
would bill the code 73130 – TC and the physician who read the x-ray would bill the code 73130-26
Do not report modifiers
26 and TC on the same procedure code on one line of service.
Modifier 26 and TC are
payment modifier reportable in the first modifier field.
These modifiers would
change the reimbursement.
Modifier 26 and TC are
used with Surgery (Urodynamics), Radiology and Lab codes.
Note: It’s
inappropriate to bill both the technical and professional components to the
same TIN number (whether on separate line items of a single claim or on
separate claims).
If the technical and
professional components were performed by the same provider or by different
providers, if both components will be billed under the same tax ID number (TIN)
then both components were performed by the same provider and are not eligible
to be reported as separate components. Instead, the global service should be
billed without modifier TC or 26