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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

Originally Created: 02/01/2009

Section: Modifiers Policy No: 106
Last Reviewed: 06/01/2014 Last Revised: 06/01/2014
Approved: 06/10/2014 Effective Date: 07/01/2014

This policy applies to all physicians, other qualified health care professionals, hospitals and other facilities.

Definitions

Modifier 26
Current Procedural Terminology (CPT®) modifier 26 represents the professional (provider) component of a global 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
HCPCS Level II modifier TC represents the technical component of a global 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.

A global service
A global service represents a complete service or procedure that includes both the professional and technical components.

Policy Statement

The Centers for Medicare & Medicaid Services (CMS) designate which procedure codes are valid for use with modifier 26 and modifier TC. Our health plan utilizes these CMS designations in determining procedure code/modifier combinations that are valid for our use.  Procedure code/modifier combinations that are considered not valid for our health plans 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.

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

References

Centers for Medicare & Medicaid Services (CMS), National Physician Fee Schedule Relative Value File

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

Centers for Medicare & Medicaid Services (CMS). "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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