Most radiology services or procedures, although described by a single CPT code, comprise two distinct portions: a professional component and a technical component. The professional component is provided by the physician and may include supervision, interpretation, and a written report. To claim only the professional portion of a service, CPT Appendix A i.e., Modifiers, instructs you to append modifier 26 to the appropriate CPT code. The technical component of a service includes the provision of all equipment, supplies, personnel, and costs related to the performance of the exam. To claim only the technical portion of a service, append modifier TC to the appropriate CPT code. Modifier 26 and Modifier TC are unique coding tools that may be used in specific circumstances. It can be easy to become perplexed trying to keep the components of a procedure straight and remembering when these modifiers should be applied. To remove some of the confusion, in this article we will explore common uses of modifiers 26 and TC and discuss the requirements of when and how to utilize them correctly. Understanding the appropriate use of modifiers 26 and TC is key to filing clean claims and avoiding denials for duplicate billing.
Defining Modifier 26 and Modifier TC
Modifier 26 (Professional Component): Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
Modifier TC (Technical Component): Under certain circumstances, a charge may be made for the technical component alone. Under those circumstances, the technical component charge is identified by adding modifier TC to the usual procedure number. Technical component charges are institutional charges and not billed separately by physicians.
A global service includes both professional and technical components of a single service. It is identified by reporting the eligible code without modifier 26 or TC. In such cases, the provider is reimbursed for the equipment, supplies, and technical support, as well as the interpretation of the results and the report. When reporting a global service, no modifiers are necessary to receive payment for both components of the service. The surest way to identify codes with separate professional and technical components for Medicare payers is to consult the National Physician Fee Schedule Relative Value File, available as a free download from the Centers for Medicare & Medicaid Services (CMS) website. If the Relative Value File lists separate line items for a code with modifiers 26 and TC, the service or procedure described by that code includes both a technical and professional component.
For instance, the 2015 Relative Value File lists three separate lines for 74020, Radiologic examination, abdomen; complete, including decubitus and/or erect views. The first of these lines corresponds to the “global” service. The second line details the technical component only, and the third line describes only the professional component. Note that the separate relative value units (RVUs) assigned for the technical and professional components will equal the total RVUs for the global service (described below). The total RVUs for 74020 is 1.04, of which 0.66 RVUs are attributed to the technical component and 0.38 are attributed to the professional component.
A chest X-ray is performed in a freestanding radiology clinic, and a physician who is not employed by the facility interprets the films. The clinic will append modifier TC to the appropriate chest X-ray code (e.g., 71010-TC, Radiologic examination, chest; single view, frontal-technical component) to account for the cost of supplies and staff. The physician who interprets the X-ray submits a claim with modifier 26 appended (i.e., 71010-26). The fee for the service will be split, with approximately 60% of payment allotted for the technical component, and 40% for the professional component.
A global service includes both the professional and technical components of a single service. When reporting a global service, no modifiers are necessary to receive payment for both components of the service. If the provider who interprets the film also owns the equipment, a global service is submitted and the professional and technical components are billed together (e.g., the appropriate CPT code is reported without either modifier 26 or TC appended). The global procedure code is submitted at a full fee.
Code 72040, Radiologic examination, spine, cervical; two or three views, includes both a technical component (the X-ray machine and necessary supplies and clinical staff to support its use) and a professional component (physician supervision, interpretation, and report). If spinal X-ray is performed at the physician’s office, either by a physician or a technician employed by the practice, report 72040 without a modifier because the practice provided both components of the service.
Note that radiologists who provide services for Medicare patients in a hospital or facility setting cannot claim the technical component of a procedure. Under the diagnosis-related group, the hospital/facility receives compensation for the technical portion of Medicare inpatient services. Similarly, Medicare rules require that payment for nonphysician services provided to hospital patients (such as the services of a technician administering a diagnostic test) are made to the hospital.
Although the majority of 7XXXX-series codes do include technical and professional components, if the fee schedule does not list separate values for a code with modifiers 26 and TC (e.g., 77071, Manual application of stress performed by the physician or other qualified health care professional for joint radiography, including contralateral joint if indicated), the modifiers are not appropriate with that code under any circumstances.
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