TC and 26

rbassett

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Do the TC and 26 modifiers need to be used when the test is split up between 2 different office locations on different days? The 2 locations are in different states but in the same company.
Thanks!
 

fhalamuda

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Do the TC and 26 modifiers need to be used when the test is split up between 2 different office locations on different days? The 2 locations are in different states but in the same company.
Thanks!

Do these happen to be either radiology or pathology tests where the interpretation of the results are being done at the second office location on the later date?
 

fhalamuda

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It is for a diagnostic test. 92083 to be exact.
Thanks

I'm not confident with the parts of ophthalmic tests but I understand this CPT code can represent a unilateral or bilateral exam. So you would not use the 26 and TC modifiers to split the procedure if for example for the patient's sake the two unilateral exams were performed at different office locations.

I am certain that you would bill the 92083 in two separate parts - each separate part with either a 26 or a TC - if the test(s) were performed in one location and the interpretation of the test results were done in a different location.


I hope this input is at least minimally helpful.
 

rbassett

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Coeur d'Alene, ID
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I'm not confident with the parts of ophthalmic tests but I understand this CPT code can represent a unilateral or bilateral exam. So you would not use the 26 and TC modifiers to split the procedure if for example for the patient's sake the two unilateral exams were performed at different office locations.

I am certain that you would bill the 92083 in two separate parts - each separate part with either a 26 or a TC - if the test(s) were performed in one location and the interpretation of the test results were done in a different location.


I hope this input is at least minimally helpful.

Yes that is what I was thinking as well. Thank you!
 

fhalamuda

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I am certain that you would bill the 92083 in two separate parts - each separate part with either a 26 or a TC - if the test(s) were performed in one location and the interpretation of the test results were done in a different location.

It might have helped if I included in my prior post for you that this separation of the 26 and TC components can be especially important for Medicare. When the professional (26) and technical (TC) components are performed in different locations, it can represent a difference in the GPCI (Geographic Practice Cost Index) part of the Medicare fee schedule. When the 26 and TC components are performed in different locations, Medicare typically needs to know the exact ZIP Code for each of the two locations so that they reimburse the two components at the right rates based the respective Zip Code's GPCIs.
 
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