Wiki TC Modifier - billing procedure

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yustun

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We are an OB/GYN office and billing procedure 76830 and 76856 w/-TC mod. We own the machine and technician works for us. Our doctor just doesn't read them anymore and one insurance denies them saying only facilities can bill -TC mod. Pls. help!!
 
Some insurance companies just dont pay for anything that is done in the office. Sometimes you will have to get a contract from the insurance to be able to do a procedure or test in the office. If that insurance doesnt pay for radiology services in the office then you would need to get in touch with your provider rep and have them add this to your contract
 
Definitely frustrating when carriers put up road blocks to payment! Have you appealed any of these cases? If not, you might have some success providing proof you are "licensed" to provide these services, and proof the equipment is owned by you. The appeal should be done via the insurance carrier representative assigned to your company. Would not hurt to appeal a few claims to find out how their process works! :)
 
Unfortunatelly we are out of network with Horizon. But that is a good idea hewitt! I will send them a proof along with an appeal letter. Since all the other insurances are paying w/out any problem we know there is nothing wrong w/the way we are billing. If that does not work, I will just tell the doctor to read them as well:)
 
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