Since we are coding different facilities with so many CPT codes, we have to use modifiers also along with CPT codes. This modifier alter the payment service and which helps in the proper payment for the procedure performed by the physician. Similarly today we are going to find out which CPT codes can be assigned 26 and TC modifier based on which we can go ahead and assign these modifier to the respective CPT codes to get the final payment for the physician.

But most of the times the physician don’t get their payment due to incorrect assigning of modifiers to the CPT codes. Even a two digit modifier can alter the total definition of the procedure, hence it will automatically reduced or increased the payment, which in either way wrong practices. So today we will chech the CPT codes compatible with 26 and TC modifier based on some indicators using a free tool. Let us checkout step by step.

Step 1 – Go to the tool and enter the information

First you have to visit the below link to get to the below tool window as shown below.

https://www.cms.gov/medicare/physician-fee-schedule/search

Now, as shown below just select the information in different tabs. For type of information on select Payment policy indicators, so that we will get only selected information only.

As you can see we have search for CPT code 93970 and hit the Search button to get the results.

93970– DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE BILATERAL STUDY

After hitting the search button, we get the below results, as you can see it shows ‘1‘ as indicator in PCTC column. This indicators says

“1 = Diagnostic tests or radiology services”. Modifiers 26 and TC can be used with these codes.

That is the reason , most of the radiology codes from 70000 series are appended with 26/TC modifier.

Step 2 : Search for different CPT codes

Now if you search for another CPT code 93010, it shows ‘2‘ as indicator. Now the ‘2‘ indicators says

2 = Professional component only codes. Modifiers 26 and TC can’t be used with these codes

93010 – ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY

As you can see  the code description of CPT code 93010, which say “interpretation and report only”. This means this code is reported for professional component only and includes all the professional services. So, here no need to add any 26 modifier since the code itself says it includes professional services. Hence, this code cannot be assigned with 26 and TC modifier.

Step 3: Payment indicators

Now when we search for CPT code 93005, it shows ‘3’ as indicator. This indicator says

3 = Technical component only codes, Modifiers 26 and TC can’t be used with these codes

Below is the code description of 93005

93005 – ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT

As per the description, the code includes “tracing only, without interpretation and report” which mean only the Technical component is included in this code. This code includes the technical component (such as staff and equipment costs) of selected diagnostic tests and hence 26 and TC modifiers can’t be used with these codes.

Step 4

Now when we search for CPT code 20610, it shows ‘0’ as indicator. This indicator says

0 = Physician service codes, Modifiers 26 and TC can’t be used with these codes.

Below is the code description of CPT code 20610.

20610 – ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE

Since, these are physician services, the concept of PC or TC doesn’t apply since physician services can’t be split into professional and technical components

Conclusion

1 – Modifiers 26 and TC can be used

2- Modifiers 26 and TC can’t be used

3- Modifiers 26 and TC can’t be used

0- Modifiers 26 and TC can’t be used