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Regence BCBSO Reimbursement Policy

Modifier -26; Professional Component
Modifier
-TC; Technical Component

Topic: Modifier -26; Professional Component; Modifier -TC; Technical Component Date of Origin: February 2009
Section: Modifiers Policy No: 106
Last Reviewed Date: June 2013 Last Revised Date: February 2009

Description

This policy applies to all physicians, other providers, hospitals and other facilities.

CPT modifier -26 represents the professional (provider) component of a service or procedure and includes the provider work, associated overhead and professional liability insurance costs. This modifier corresponds to the human involvement in a given service or procedure.

HCPCS Level II modifier -TC represents the technical component of a service or procedure and includes the cost of equipment and supplies to perform that service or procedure. This modifier corresponds to the equipment/facility part of a given service or procedure.

Unmodified procedure codes represent a complete service or procedure that includes both the professional and technical components.

Policy Statement

The Centers for Medicare and Medicaid Services (CMS) designate which procedure codes are valid for use with modifier -26 and modifier -TC. Regence utilizes these CMS designations in determining procedure code/modifier combinations that are valid for Regence use.  Procedure code/modifier combinations that are considered not valid for Regence use will be denied.

Correct coding guidelines require that modifier -26 be used when the professional component of a global service is the only service provided (i.e. supervision and/or interpretation codes.)

Correct coding guidelines require that modifier -TC be used when the service provided represents only the equipment or facility component of a global service and not the professional component of the same service. Hospitals frequently provide only the technical component of some services. Hospitals are not currently required to submit the -TC modifier, but will be reimbursed as if the -TC had been billed.

Unmodified procedure codes should be reported when a single provider or entity performs both the professional and technical components of a given service.

References

National Physician Fee Schedule Relative Value File

American Medical Association. “Appendix A: Modifiers” Current Procedural Terminology (CPT). AMA Press

Centers for Medicare and Medicaid Services. “Appendix A: Modifiers”. Health Care Procedure Coding System (HCPCS). Ingenix

Cross References

None


Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.

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