Modifier -26; Professional
Modifier -TC; Technical Component
|Topic: Modifier -26; Professional
Component; Modifier -TC; Technical Component
||Date of Origin: February
||Policy No: 106
|Last Reviewed Date: June 2013
||Last Revised Date: February 2009
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
Unmodified procedure codes represent a complete service
or procedure that includes both the professional
and technical components.
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.
National Physician Fee Schedule Relative Value File
American Medical Association. “Appendix A:
Procedural Terminology (CPT). AMA Press
Centers for Medicare and Medicaid Services. “Appendix
A: Modifiers”. Health
Care Procedure Coding System (HCPCS). Ingenix
Your use of this Reimbursement Policy constitutes your agreement to be bound
by and comply with the terms and conditions of the Reimbursement
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