Global vs split billing for imaging

[arnoldmel]

I am looking for supporting documentation on how to bill Medicare secondary when global code for imaging was paid by the primary insurance. We are trying to prevent a claim write off.
I am finding conflicting information; can I split the claim to Medicare secondary with modifiers TC and PC?
If so, how should the CPT codes be split on the CMS 1500?

 

[sls314]

I am looking for supporting documentation on how to bill Medicare secondary when global code for imaging was paid by the primary insurance. We are trying to prevent a claim write off.
I am finding conflicting information; can I split the claim to Medicare secondary with modifiers TC and PC?
If so, how should the CPT codes be split on the CMS 1500?

The purpose of TC/PC billing is to allow the entity that owns the imaging equipment to be paid for the technical component (TC), while the provider who interprets the study is paid for the professional component (PC).

If the provider’s office owns the equipment and both portions of the service are being billed by the same entity, then the claim is billed globally. There’s no need to split the TC and PC components to divide the payment between 2 separate entities.

That brings up a couple of questions:

1. Was the primary insurer correctly billed with the global code?
2. Why do you think billing Medicare secondary for the global code would result in a claim write-off?

 

[arnoldmel]

The purpose of TC/PC billing is to allow the entity that owns the imaging equipment to be paid for the technical component (TC), while the provider who interprets the study is paid for the professional component (PC).

If the provider’s office owns the equipment and both portions of the service are being billed by the same entity, then the claim is billed globally. There’s no need to split the TC and PC components to divide the payment between 2 separate entities.

That brings up a couple of questions:

1. Was the primary insurer correctly billed with the global code?
2. Why do you think billing Medicare secondary for the global code would result in a claim write-off?

The provider office owns the equipment and performs the diagnostic test in the office (TC) and per contractual agreement a radiologist off site to read images (PC). The CMS anti-markup rule to separate TC and 26 does not apply to commercial insurance so claim was billed globally to primary. Does the CMS anti-markup rule apply to Medicare secondary claims?