Wiki -TC Modifier and BCBS

[jcp703@aol.com]

We are receiving rejections from BCBSNJ when billing out ultrasound codes with a -TC modifier. Another physician is reading the claim, our office is strictly performing the ultrasound. Does anyone have a policy on this or any information pertaining to the use of this modifier? Thanks!

 

[s_harris14]

Based on the information given, you are using the modifier correctly. What is BCBSNJ's denial code/reason for the denial?

Can you verify with the reading physician's billing group/department that they are appending the modifier 26 for the professional component? If they are billing the CPT code without any modifier, the insurance company is paying them for both components - technical and professional. If you can't ask the reading provider's group directly, ask BCBSNJ.

I hope that helps!
Stephanie Harris, CPB

 

[CodingKing]

I see it every day where I work. Typically one forgets to append the modifier and first to get the claim in wins.

 

[Cindy Akkerman]

Bcbs

Also check their medical policy, BCBS has been known to have some interesting medical policies on stuff. Check with the 26 claim to verify they are not billing it globally. Submit documentation to BCBS to appeal. Unless there is an issue with the medical policy, it sounds like the 26 is billing globally.