CPT modifier 26 and TC and indicators

Modifiers 26 and TC

Recently Palmetto GBA has noticed a number of diagnostic services being filed on the same day by different providers. In some of these instances one provider has filed for either the professional or the technical component while the other provider has filed a global charge. It is important to make sure you only file for the portion of the services you rendered.

If you are billing for the interpretation or the technical component of a diagnostic procedure, p lease ensure that you use the appropriate modifier. If you are performing the professional component of a service you should indicate this by using the 26 modifier. If you are performing the technical component of the service you will need to indicate this using the TC modifier. Please note that only one service for each component is appropriate per service and absence of a modifier indicates a global service and failure to utilize the appropriate modifier will result in an overpayment made to your office.

Technical Component TC - For recipients with Medicare and Medicaid, providers should submit the claim to Medicaid with the same modifiers used for Medicare. For recipients without Medicare coverage, the following modifiers are to be used. Modifier usage is not applicable to all Procedure  codes. Please refer to the most current Procedure  manual for codes exempt from modifier usage.


26 – Professional Component Professional portion only of a procedure that typically consists of both a professional and a technical component (e.g., interpretation of laboratory or x-ray procedures performed by another provider) 40% of the fee on file





Diagnostic Test (26 & TC)

Category         Indicator          Indicator Description



0
Physician Service codes. Indicator identifies codes that describe physician services such as visits and surgical procedures. Mod 26 & TC cannot be used with these codes.


1
Diagnostic tests or radiology services. Codes generally have both a professional and technical component. Modifiers 26 and TC can be used with these codes.


2
Professional component only codes. This indicator identifies stand alone codes that describe the physician work portion of selected diagnostic tests for which there is an associated code that describes the technical component of the diagnostic test only and another associated code that describes the global test. Modifiers 26 and TC cannot be used with this code.


3
Technical component only codes. This indicator identifies stand alone codes that describe the technical component of selected diagnostic tests for which there is an associated code that describes the professional component of the diagnostic test only. It also identifies codes that are covered only as diagnostic tests and therefore do not have a related professional code. Modifiers 26 and TC cannot be used with this code.


4
Global test only codes. This indicator identifies stand alone codes that describe selected diagnostic tests for which there are associated codes that describe a) the professional component only and b) the technical component of the test only. Modifiers 26 and TC cannot be used with these codes.

A View of the MPFS (PC/TC)

Billing Example – Procedure  93000

*Procedure  code 93000 has a PC/TC “4” indicator on MPFS Relative Value file

*Code described as global test only

*Modifier 26 or TC should not be appended to this procedure code


Billing Example – Procedure  93005

*Procedure  code 93005 has a PC/TC “3” indicator on MPFS Relative Value file

*Code described as technical component only

*Modifier 26 or TC should not be appended to this procedure code

Billing Example – Procedure  93010

*Procedure  code 93010 has a PC/TC “2” indicator on MPFS Relative Value file

*Code described as interpretation only

*Modifier 26 or TC should not be appended to this procedure code


Common Billing Errors (Mod 26 & TC)

*Modifier 26/TC used on same claim line for global procedure

*Modifier 26 and TC appended to office visit and injection procedure codes

*Modifier 26 billed on codes that have a PC/TC indicator “2”

*Modifier TC billed on codes that have a PC/TC indicator “3”


CPT surgery Modifiers

CPT modifier 62 and 66

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