When to Apply Modifiers 26 and TC
Modifiers 26 and TC are unique coding tools that may be used in specific circumstances. It can be easy to become perplexed trying to keep the components of a procedure straight and remembering when these modifiers should be applied. To dispel some of the confusion, this article will explore common uses of modifiers 26 and TC and discuss the requirements of when and how to utilize them correctly. Understanding the appropriate use of modifiers 26 and TC is key to filing clean claims and avoiding denials for duplicate billing.
In procedure coding, you’ll find that certain services and procedures, although described by a single CPT® code, are comprised of two distinct portions: a professional component and a technical component. Most often, you’ll see this among diagnostic procedures and services such as radiology, stress testing, cardiac catheterization, etc. When the professional component of one such procedure is performed separately, the specific service performed by the physician may be identified by adding modifier 26 professional component. Let’s break that down a little further.
Defining Modifier 26
The professional component is outlined as a physician’s service, which may include technician supervision, interpretation of results, and a written report. To claim only the professional portion of a service, CPT® Appendix A (Modifiers) instructs you to append modifier 26 to the appropriate CPT® code.
- To bill for only the professional component portion of a test when the provider utilizes equipment owned by a hospital/facility
- To report the physician’s interpretation of a test, which is separate, distinct, written, and signed
- When the same provider performs both the technical and professional components; unless the same provider reports both components and the technical portion is purchased
- Reporting it for re-read results of an interpretation provided by another physician
- Appending it to:
- Global test-only codes
- Professional component-only codes
- Technical component-only codes.
- For example, a facility performs a 12-lead EKG and has an independent physician read the strip: 93005 Tracing only (facility) and 93010 Interpretation and report only (physician).
Defining Modifier TC
The technical component includes the provision of all equipment, supplies, personnel, and costs related to the performance of the procedure. The payment for the technical component portion also includes the practice expense and the malpractice expense. To claim only the technical portion of a service, append modifier TC Technical component to the appropriate CPT® code. Fees for the technical component are generally reimbursed to the facility or practice that provides or pays for the supplies, equipment, and/or clinical staff (technicians).
- To bill for only the technical component of a test
- When billing both the professional and technical component of a procedure when the technical component was purchased from an outside entity; the provider would bill the professional on one line of service and the technical on a separate line.
- When the physician performs both the professional and technical components on the same day
- Appending it to:
- Global test-only procedure codes
- Professional component-only procedure codes
- Technical component-only procedure codes
Note: Hospitals are typically exempt from appending modifier TC because it is assumed that the hospital is billing for the technical component portion of any onsite service. Consult individual payers for specific coding instructions.
Consider the Global Service
A global service includes both professional and technical components of a single service. It is identified by reporting the eligible code without modifier 26 or TC. In such cases, the provider is reimbursed for the equipment, supplies, and technical support, as well as the interpretation of the results and the report. When reporting a global service, no modifiers are necessary to receive payment for both components of the service.
The surest way to identify codes with separate professional and technical components for Medicare payers is to consult the National Physician Fee Schedule Relative Value File, available as a free download from the Centers for Medicare & Medicaid Services (CMS) website.
If the Relative Value File lists separate line items for a code with modifiers 26 and TC, the service or procedure described by that code includes both a professional and technical component. If the fee schedule does not list separate values for a code with modifiers 26 and TC, the modifiers are not appropriate with that code under any circumstances.
Know When to Use Modifiers 26 and TC
It’s very important to know when to bill globally and when to segregate a code into professional and technical components. Separate payments may be made for the technical and professional components of a procedure if, for example, a facility provides the technical component of a service/procedure, while an individual physician performs the professional component. The physician bills the procedure code for that service with modifier 26 appended, and the facility bills the same procedure code with modifier TC.
If, however, a physician provides both the professional component (supervision, interpretation, report) and the technical component (equipment, supplies, and technical support) of a service, that physician would report the global service — the procedure code without the TC or 26 modifier. This may be the case if an X-ray of a broken bone is taken in the orthopedic surgeon’s office.
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). Just as there are codes that describe professional-only services for Medicare, so are there codes describing technical component-only services. Do not append modifier TC if there is a dedicated code to describe the technical component, for example, 93005 Electrocardiogram; tracing only, without interpretation and report.
Before using either modifier, you should check whether the procedure code can accept these modifiers. An indicator of “1” in the Professional Component (PC)/Technical Component (TC) field on the Medicare Physician Fee Schedule Database (MPFSDB) signifies that modifiers 26 and TC are valid for the procedure code.
A chest X-ray is performed in a freestanding radiology clinic, and a physician who is not employed by the facility interprets the films. The clinic will append modifier TC to the appropriate chest X-ray code (e.g., 71045-TC, Radiologic examination, chest; single view-technical component) to account for the cost of supplies and staff. The physician who interprets the X-ray submits a claim with modifier 26 appended (e.g., 71045-26). The fee for the service will be split, with approximately 60 percent of payment allotted for the technical component, and 40 percent for the professional component.
Code 72040 Radiologic examination, spine, cervical; 2 or 3 views includes both a technical component (X-ray machine, necessary supplies, and clinical staff to support its use) and a professional component (physician supervision, interpretation, and report). If a spinal X-ray is performed at the physician’s office, either by a physician or a technician employed by the practice, report 72040 without a modifier because the practice provided both components of the service. When reporting a global service, no modifiers are necessary to receive payment for both components of the service.