Wiki TC Modifier on Labs for Medicaid IL


Best answers
Hello all,

Just wondering if any are receiving notices from Medicaid IL regarding the TC Modifier. I have never heard of using a TC modifier on a laboratory service before??? In what scenarios as a facility would you bill for the entire service? From a coding perspective, I am having a difficult time justifying using this on every Medicaid claim. I did look at the hospital manual and it looks like the verbage is reading as follows:

HFS L-210 (1)

L-210.1 Technical and Professional Components For any given lab test, no more than one provider may be reimbursed for the technical component of a service and no more than one provider may be reimbursed for the professional component. Practitioners billing the technical component only must use modifier “TC”. Practitioners billing the professional component only must use modifier “26”. Both technical and professional components are implied when no modifier is entered.

=L-210.1.2 HFS 2360 Claim Form Revised June 2018
Hospitals frequently utilize reference laboratories (an off-site laboratory that completes the procedure on the specimen provided to them). If a reference laboratory has a financial agreement with a hospital to provide services for a hospital, then the hospital is entitled to bill the Department for both the professional and technical components of the service rendered at the lab for outpatient services. If no such financial agreement exists, the laboratory may submit charges to the Department.

Any thoughts on this??

Thank you,