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Separate professional/technical charges for lab codes 80047 an 80048

  1. Smile Separate professional/technical charges for lab codes 80047 an 80048
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    Providers are billing separate charges for technical (hospital) component and professional (lab) component of codes 80047 and 80048. Per NCCI, these codes do not have a separate technical/professional component therefore the hospital is billing the total component (no modifier applied) and receiving payment. The lab is billing the 26 modifier (professional component) and receiving zero payment stating that the billed code, 80047, does not have a separate technical/professional component. Is it correct to deny the billing with the 26 modifier stating that the code does not have a separate technical/professional component?

  2. #2
    Medical Billing
    The PC/TC concept does not apply to these codes. They are automated labs so no professional component.
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

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