Basics about Modifier 26 (Professional component) and TC (Technical component)

In diagnostic radiology, we mostly use 26 modifier and Technical Component (TC). However, still many of us have a lot of difficulty in understanding the use of these modifiers. I myself initially was struggling to use these modifiers. Modifiers are always little tricky to apply with CPT codes. Modifiers play an important role in modifying the procedure and changing the dollar value of the procedure code.  We have already learnt previously about how to use 58 and 78 modifier, now we will learn more about Modifier 26 (PC) and TC (Technical component).

Read also: Learn how to use 25 and 27 modifier

Difference between 26 modifier (PC) and TC modifier

If you have coded diagnostic procedures, you will be very familiar with 26 modifier. This modifier is used very frequently in diagnostic radiology CPT codes. For physician side or professional services, one who reads and interprets the report usually has to assign 26 modifier. Technical Component (TC) is assigned when the physician does not own the equipment or facilities or employs the technician.

In short, 26 modifier is assigned to pay for the physician services only.

While TC modifier is assigned for the facilities used or the equipment used to perform the procedure.

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Points to check for 26 (PC) and TC modifier

For 26 modifier, the physician supervises and interprets the results. For example, a boy fall and get some injuries in hand and then he goes to the physician office, the physician thinks he has fracture and wants and X-ray. The physician does not have equipment for X-ray. Therefore, the boy is sent to urgent care department to take an X-ray. Now, the boy returns to the same physician. The physician interprets the result from the films obtained through X-ray machine. Now, here you can understand very well, how the procedure worked. So, now we have to bill the procedure for both the physician and the urgent care department.

73130-26 (X-ray of hand, three views)

73130-TC (X-ray of hand, three views)

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PC/TC indicators
Centers for Medicare & Medicaid (CMS) PC/TC indicators are found in the CMS National Physician Fee Schedule Relative Value File. Values which are currently in the CMS file are:

0 – Physician service only codes. The concept of PC/TC does not apply.
1 – Diagnostic tests for radiology services. Both modifiers 26 and TC can be used with these codes.
2 – Professional component only codes. Modifiers 26 and TC cannot be used with these codes.
3 – Technical component only codes. Modifiers 26 and TC cannot be used with these codes
4 – Global test only codes. These are selected diagnostic tests that describe a) the professional component of the test only, and b) the technical component of the test only. Modifiers 26 and TC cannot be used with these codes.

5 – Incident to codes. These are services covered incident to a physician’s service when provided by auxiliary personnel employed by and working under physician. Modifiers 26 and TC cannot be used. Services cannot be paid when they are rendered to patients in inpatient or outpatient hospital setting.
6 – Laboratory physician interpretation codes. Actual performance of the test is paid under the lab fee schedule. Modifier TC cannot be used. Physician performing interpretations of these codes must be billed with modifier 26. These services can be paid under the physician fee schedule if they are furnished to a patient by a hospital pathologist or an independent laboratory.
7 – Physician therapy service, for which payment may not be made when the service is billed by an independently practicing physical or occupational therapist to a patient in an inpatient or outpatient hospital setting.
8 – Physician interpretation codes. This is for physician interpretation of an abnormal smear for hospital inpatient. No TC billing is recognized. The actual test is paid through inpatient PPS rate.
9 – Not applicable. The concept of TC/PC does not apply.

Remove Confusion about TC component

Since CPT codes are intended to represent physician and other healthcare practitioner services, CPT does not contain a coding convention to designate the technical component for a procedure or service. However, many third-party payors have established modifiers and/or specific reporting policies regarding the reporting of the technical component.

For example, Medicare established the -TC modifier for reporting the technical component. 

“Professional and technical component modifiers were established for some services to distinguish the portion of a service furnished by a physician. The professional component includes the physician work and associated overhead and professional liability insurance (PLI) costs involved in three types of services:

• diagnostic tests that involve a physician’s interpretation, such as cardiac stress tests and electroencephalograms;
• diagnostic and therapeutic radiology services; and
• physician pathology services.

The technical component of a service includes the cost of equipment, supplies, technician salaries, etc. The global charge refers to both components when billed together. For services furnished to hospital outpatients or inpatients, the physician may bill only for the professional component, because the statute requires that payment for nonphysician services provided to hospital patients be paid only to the hospital. This requirement applies even if the service for a hospital patient is performed in a physician’s office.”

Technical component charges are institutional charges and not billed separately by physicians. However, portable x-ray suppliers only bill for technical component and should utilize modifier TC. The charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles.

Read also: Best Successful Tips for Clearing CPC exam

Professional versus Technical Component for Clinical Laboratory Services (CPT codes 80049–87999)

The use of the -26 modifier is required for CPT codes 80049–87999 in those instances when the physician is only billing for the professional component of the laboratory test (ie, medical direction, supervision or interpretation). This method of reporting is appropriate when the technical and professional components are reported separately.

There are a number of ways to report the professional services of the physician in the hospital clinical laboratory. The physician may bill the patient (or patients insurer) or the hospital. Since the hospital’s Medicare payment rate includes payment for certain physician services, Medicare rules require the physician to seek payment from the hospital for medical direction and supervision of clinical laboratory tests. Billing using the -26 modifier is allowed for interpretation of specified tests.

For non-Medicare patients, pathologists and hospitals frequently negotiate different billing arrangements for professional services. 

“Professional component billing is one valid method of billing for the professional services of pathologists in the clinical laboratory. In many communities, the standard practice is for the pathologist to direct bill patients for the professional component of clinical laboratory services. When the pathologist bills a professional component to a non-Medicare patient, no payment is made by the hospital to the pathologist for this service. The hospital’s bill for the technical component covers hospital costs for laboratory equipment, supplies and non-physician personnel – it does not include the professional services of the pathologist.”

In closing, when reporting the technical component of a procedure or service, it is important to familiarize yourself with the various reporting requirements of individual insurance companies in your area. These reporting and reimbursement policies may vary from one insurance company to another.

Read also: Clear Confusion about CPT code 76376 and 76377  for 3D

Do and Don’t for 26 and TC modifier

Use TC modifier only for the medical equipment, Facility or the technician. Using only TC modifier indicates only the technical portion of the procedure is used.

Use 26 modifier for the physician or professional services only. Also, do use them for CPT codes like 93101 with description interpretation and report only.

When both the professional and technical portion is provided by the physician, we are not supposed to use 26 or TC modifier along with CPT code. In such case, the CPT code will be a global code like 73130 only.

Read also: Superb coding tips for Procedure code 36569

Indicators for 26 and TC modifier while using with CPT code

Before using the 26 or TC modifiers, you should check whether the procedure code can accept these modifiers. An indicator of “1” in the PC (Professional Component)/ TC (Technical Component) field on MFSDB (Medicare Physician Fee Schedule Database) signifies that Modifiers 26 and TC are valid for the procedure code. Now, how to find out the indicators? Just click below link, to check the eligibility of CPT code for 26 or TC modifiers.

https://www.novitas-solutions.com/webcenter/portal/MedicareJH/FeeLookup?_afrLoop=405898022136168

 Now, just enter any CPT code, like 72100 and enter the modifier 26 or TC in the second box with Date of service (DOS). You can enter the rest of information by yourself.

Now, once you enter all the information, just click the “Search” button. 

As you can see above, the Professional /Technical Component status indicators “1” for CPT code 72100. Hence, this code 72100 is eligible for modifier 26. 

There are CPT codes used which are not eligible for 26 modifier. As you can see below I have checked CPT code 93010 for eligibility. But, as you can see below, this code is not applicable for this procedure.

This the best way to know the eligibility of CPT codes for modifier 26 an TC (Technical component).