Modifier TC on UB04 form (Outpatient Hospital Billing)

kumeena

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Good Morning Everyone,

I work for Hospital outpatient billing. Today someone told me that I do not need to enter "TC" for my Ultrasound or any Procedures (Ex:76815,76817,93303,93320,92250 etc.,) .
Reason: Claim UB04 itself is used for Hospital billing .

Please confirm.

Thank you & Have a nice weekend.
 

CodingKing

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Correct. Its assumed the Hospital is billing for the technical component only on UB. 26 vs TC is for CMS 1500 form only
 

thomas7331

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Can you tell me where CMS states this?
It is not a CMS rule - it is based on the nature of the UB-04 billing. The revenue code will tell you whether or not the services is technical or professional. Professional services are rarely billed on UB-04 form (and most payers would not even accept them billed this way), but if they are included on the UB-04 they would have to be billed using revenue codes 960-989. Other revenue codes never include professional services, so it is understood just based on revenue code descriptions that they are always technical only. The TC modifier would be redundant and is unnecessary in this context.

I've been involved with hospital billing for 20 years and never encountered a payer that required the TC modifier on a UB-04 claim, but if you need an official reference, then I'd recommend looking for this in the Uniform Billing Editor/UB-04 manual which contains the regulations governing the use of the UB-04 form.
 
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DevonaG

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It is not a CMS rule - it is based on the nature of the UB-04 billing. The revenue code will tell you whether or not the services is technical or professional. Professional services are rarely billed on UB-04 form (and most payers would not even accept them billed this way), but if they are included on the UB-04 they would have to be billed using revenue codes 960-989. Other revenue codes never include professional services, so it is understood just based on revenue code descriptions that they are always technical only. The TC modifier would be redundant and is unnecessary in this context.

I've been involved with hospital billing for 20 years and never encountered a payer that required the TC modifier on a UB-04 claim, but if you need an official reference, then I'd recommend looking for this in the Uniform Billing Editor/UB-04 manual which contains the regulations governing the use of the UB-04 form.
so why do we append the 26 to a 1500? Wouldn't it be the same theory?
 

thomas7331

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so why do we append the 26 to a 1500? Wouldn't it be the same theory?
No, the global, technical and professional components all can be billed on the 1500 form, for example in situations where physicians offices have their own x-ray equipment or pathology labs on site. So unlike the UB-04 which has revenue codes that are reserved for technical or professional services, on the 1500 form the modifiers are the only way to distinguish these.
 
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