A Quick Guide to Modifier 26 and Modifier TC

A Quick Guide to Modifier 26 and Modifier TC

Occasionally, the total service/procedure described by a single CPT® code is comprised of two distinct portions: a professional component (modifier 26) and a technical component (modifier TC).

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 (modifier TC) 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.

Certified Interventional Radiology Cardiovascular Coder CIRCC

For example: Radiology 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 568 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.

39 Responses to “A Quick Guide to Modifier 26 and Modifier 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

  20. Carol D says:

    You only attach the modifier 26 to the professional charges not the facility.

  21. Israel E says:

    A Ultrasound Facility that pay for outsider reading company can bill for modifier 26?

  22. Debra says:

    Hi. Opthomology code 92136 billed for initially oil without modifiers. Cover prof component and tech component. However. When the second Eye is done can I bill 92136 with a 26 modifier for the seconds Eye to Medicare ?

  23. joe says:

    can we use modifier 26 for labs like 88341?

  24. Amy F says:

    Our office is in question of whether the PC side of billing is to be charged as Date of Exam or Date Read? We were billing as Date Read but the insurances are applying Mamo’s to deductible if our radiologists have to wait for comparison view and read it the next day. Please help anyone provide me with actual written guides as to which way we are supposed to be billing these. Thanks

  25. Brandy says:

    What about remote pacer checks? It is my understanding that in an outpatient setting, we are able to bill the TC (93296) along with the PC (93294); because out tech’s are downloading these pacer check? Please advise.
    Thank you!

  26. Rosemary says:

    We have to file our lab charges on a 1500 claim & were told we had to use a TC or 26 modifier on our Blue Cross lab claims when we file using a Place of Service 19 for our off-site stand-alone lab charges. Blue Cross denies all these lab charges if we bill with this 19 POS. Any suggestions

  27. MELISSA PRUITT says:

    we file our claims on 1500 forms and we are getting a denial from bcbs that says ” procedure code invalid resubmit with corrected procedure” this is for code 71046tc and 7104626 so we are using the tc and 26 modifiers this is the new cxr code. NOT SURE WHAT THEY ARE LOOKING FOR? CAN ANYONE HELP? I WAS THINKING THAT THEY ARE LOOKING FOR THE PC AND 26 MODIFIERS JUST NOT SURE

  28. Carol says:

    I believe the new radiology CPT codes are not in effect for 2018 at the time you billed. Try rebilling with the old CPT

  29. amanda says:

    thanks for the info! any idea why our global cpt codes are being split into 26 & tc modified CPTs when we bill to certain insurances? for instance, billed charge is global 72146 thoracic mri, but eob returns with two charge lines 72146 26 modifier added, and 72146 TC modifier added. thanks in advance. any advice is appreciated.

  30. amanda says:

    these are for claims in 2017 & 2018…it started last summer.

  31. Deb says:

    If a hospital does an Echocardiogram and the physician does not dictate a report showing the procedure/results, can the hospital still bill for the technical component without a report of findings?

  32. SHARON GARRETT says:

    I am receiving many denials from BLUE CROSS on my claims where we are billing 64483 (this is getting paid) but 72275-59 is being denied this following explanation ( 00781 : CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) NATIONAL PHYSICIAN FEE SCHEDULE RELATIVE VALUE FILE (NPSFRVF) DESIGNATES THAT THE CONCEPT OF SEPARATE PROFESSIONAL AND TECHNICAL COMPONENTS APPLIES FOR THIS PROCEDURE. This charge has been denied because the place of service billed is in a facility setting, and the procedure code contains no professional component modifier.
    My place of service is 24 (Ambulatory Surgical Center). Your help / guidance is much appreciated.

  33. Marschele Friend says:

    Thank you for this article. We have an ultrasound technician who travels between three of our clinics and performs the technical component of a renal ultrasound and then sends the films out for the interpretation and report to a radiologists group outside of our practice. We add modifier TC to the CPT code but who would be the appropriate rendering physician on the claim; the referring provider from within our medical group; the designated supervising physician at the clinic; or can the medical group somehow be the rendering physician? Any insight you may have would greatly be appreciated.

  34. Michelle says:

    For billing the professional component should the date of service be the date of the test or the date it was read?

  35. Lindsey says:

    I work in a Radiation free standing facility, is the G6002 for IGRT billed with 3D supposed to have modifier 26 for the professional component . We are billing G6015 with 77014-26 for the professional component so since it is both IGRT codes would they be the same?

  36. Danielle says:

    Hello everyone! I am not sure if this is the correct thread.
    I have a physician needing to know how he would bill/code for a Endoscope that he rents out to other facilities? Does anyone have any guidance on how to properly code/bill for renting of physician owned equipment?

    Thank you!

  37. 0042T says:

    Do we have to append modifier 26 for 0042T?

  38. Angela says:

    When an EEG is done in a hospital setting and the independent physician reads the EEG “we” the physician’s office bill his professional charge. Is it appropriate to use the 26 modifier on cpt code 95827? We do not bill for the technical component, the hospital bills that charge separately.

    Thank you!
    Angela

  39. Angela C. says:

    When an EEG is done in a hospital setting and the independent physician reads the EEG “we” the physician’s office bill his professional charge. Is it appropriate to use the 26 modifier on cpt code 95827? We do not bill for the technical component, the hospital bills that charge separately.

    Thank you!
    Angela

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