9 Feb 2016


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