A Quick Guide to Modifiers 26 and TC

A Quick Guide to Modifiers 26 and TC

by John Verhovshek, MA, CPC

Occasionally, 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.

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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About Has 480 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

19 Responses to “A Quick Guide to Modifiers 26 and TC”

  1. Robin Pollitt says:

    What a great article! Thanks for making TC & 26 modifiers and their use easy to understand.

  2. CS says:

    How do you code a facility fee for an outpatient svc when a physician from another hospital performs a surgery (58970)? I know a ‘Y’ modifier should be used but not sure how to apply.
    Could it be ‘Y7610’?

  3. ASaiz says:

    Thank you for your comment. You’ll find a lot of suggestions and better answers to your question in the Member Forums.

  4. Susan Eoannou says:

    Please confirm if it is appropriate for a hospital to code and bill TC for ultrasounds performed in ED by contracted ED physician group (e.g., no hospital-employed technician is involved). Hospital owns equipment, ED is hospital facility, hospital assumes costs of physician contract, etc. If you can confirm, can you provide the source? Thank you!

  5. N says:

    What if an independent lab bills where services renderd at hospital but sent to lab.

  6. Linda says:

    Hi
    I am trying to figure out the statement that you don’t use 26 with codes that say interpretation and supervision only. That makes sense to me but I am in a group that says you still need to use it regardless? And when you put it through the AAPC coder it says you still need to add 26. Thanks Linda

  7. Beth says:

    Can 2 independent Laboratories use the same equipment?

  8. Susie Jackson says:

    Can modifiers 26 and TC be used with CPT 80307? We have a payer that states they only cover the technical component of 80307. First time we’ve seen/heard of this. Thank you!

  9. Tracy Urquidez says:

    Please confirm if it is appropriate for a hospital to code and bill TC for ultrasounds performed in ED by contracted ED physician group. Hospital owns equipment, ED is hospital facility, hospital assumes costs of physician contract, etc. If you can confirm, can you provide the source? asking the same question Susan above had asked.

  10. Megan Weinberg says:

    Are 92060 & 92250 considered global codes? I am trying to see if they require the mod 26 & tc when billed. Please advise

  11. jennifer says:

    when billing 93922 and 93925 with mod 26 which cpt code do I put the modifier on?

  12. KimF says:

    Jennifer … both 93922 and 93925 would get the -26 modifier.

  13. KimF says:

    Megan … What does your site bill for? Do you bill globally or just the Professional side or just the technical side. These codes are “just” professional like CPT 93010, or just technical …

  14. Abby K says:

    What a great article! Thanks for making TC & 26 modifiers and their use easy to understand.

  15. Laura says:

    Good Afternoon,
    I work for a dermatologist. Is it appropriate for a lab to bill a 88305 x 2units for one biopsy?? One for the preparation of the slide and one for the reading of the slide. Would the TC or 26 modifier be appropriate?
    Should they bill bill the biopsy 88505 mod 26?
    Thanks for any help!

  16. Karen Salse says:

    can you use modifier TC with CPT code 86891 when provided by a mobile unit? What cpt code is used for Cellsaver machine. Not a DME because the pt doesn’t take it home with them. Since hospital doesn’t have a Cellsaver machine, the surgeon will call for our services & we bill pt’s insurance. We are mobile units providing blood services.

  17. Carol D says:

    I have a patient that has been seen twice in the E.R at different times. I need to know what modifier to use for the professional fees for same DR. to bill Medicare.
    Thanks

  18. SREEKANTH VISWANATHAN says:

    Excellent article:
    We do esophageal manometry in newborns. It is a new procedure in newborn, done by specialized physician, who required to spend around 4-5 hrs for the procedure and interpretation. However, the procedure code 91010 is associated with only 4.97 RVU with minimal reimbursement for physician charges , considering the effort involved. Is there a way around this, is work RVU for physician time is modifiable here/
    Appreciate your help

  19. Liz F. says:

    Hello, I am missing modifiers for Medicare PT B, New York state, for x-ray procedures done by Nurse Practitioners in a walk-in family care center. The center is a clinic/group practice, multi-specialty. Should I be attaching modifier 26 to the x-rays?
    Thank you. This is a nice site to have available.
    Liz

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