Facility billing with TC/26


Local Chapter Officer
Raymore, MO
Best answers
I'm not experienced in outpatient/facility coding but need help with a question.

How do you bill for procedures when there is a TC/26 involved? For example, a specialist see's a pt in out outpt clinic and orders an EMG. HE reads the EMG. The hospital billing department needs to bill the specialists charges on a 1500 to Medicare Part B, and bill the facility charges on a UB to Medicare Part A.

How should these claims be submitted? Do we use a 26 for the professional fees and a TC for the facility fee?
I have someone saying the hospital bills the code without any modifier, because Medicare will only pay the TC anyway to the facility.Thanks for any help :confused:

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The EMG will be paid on the facility side under Medicare Part B and though it is only charging for the TC portion, on the UB the "TC" modifier is omitted. The proper revenue code would point to proper charge.
We do this exact billing at our facility, we bill the tc comp on a UB04 no modifier and the PC on a 1500 with modifier 26, you do not need to add the TC modifier to the UB because they know it's the technical already.