Professional Component

saave853

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We sub-contract the professional component (PC) and there fore need to bill for it and the technical component (TC), therefore we bill globally! CMS is denying claims because the billing provider does not match the performing provider, spoke to CMS and they say there is a modifier to indicate that you are sub-contracting the PC, but they cannot tell you what it is. Does anyone have any idea???? :confused:
 
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Florence, SC
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modifier for pc componet

you need to bill on two seperate lines the first line will be the cpt code with a TC modifier for the tech. componet and the second line will be the same cpt code with a 26 modifier for the pc componet. You will also need info for the provider that is doing your pc part like NPI as they must be a medicare provider.
 

saave853

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???

The thought had crossed my mind and it makes lots of sense, thank you. Now i have another question, on the 1500 form what block would you use to indicate the NPI for the provider doing the PC part?
 
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Florence, SC
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pc componet

If claim is going to Medicare It has to go elec and I am not sure which loop this goes in if you call prov service line at Medicare and ask for this info they will give it to you. I am not really sure if there is a place for it on the 1500 form.
 
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