February 27, 2025
Billing the Professional and Technical Components
Modifier 26
Defined as professional component (PC). Outlined as physician's service, which may include technician supervision, interpretation of results and written report. Use when physician interprets but does not perform the test.
Modifier TC
Defined as technical component (TC). Use when physician performs the test but does not do interpretation.
Appropriate Use
Most radiology services may be billed with modifier 26 or TC, or with no modifier at all, indicating the provider performed both professional and technical services. These services will have PC/TC indicator of "1" on the Medicare Physician Fee Schedule (MPFS) Relative Value File. The technical component is billed on the date test was performed. When billing global service, the provider can submit the date of service of the professional component with a date of service as the date of the review and interpretation or the date the technical component was performed. If the provider did not perform a global service and instead performed only one component, the date of service for the technical component would the date the patient received the service and the date of service for the professional component would be the date the review and interpretation is completed.
Some surgical and anatomical pathology services may have a professional and technical component. These services will also have a PC/TC indicator of "1" on the MPFS Relative Value File. The technical component is billed on the date of specimen collection (surgery date). When billing a global service, the provider can submit the professional component with a date of service when the review and interpretation is completed or can submit the date of service as the date the technical component was performed. If the provider did not perform a global service and instead performed only one component, the date of service for the technical component would be the date the patient received the service, and the professional component would be the date the review and interpretation is completed.
The TC and 26 modifiers must be reported in the first modifier field.
Inappropriate Use
- Evaluation and management or anesthesia codes
- Procedure or service descriptors that indicate professional component only
- Global test only codes, example: CPT 93000
- Professional component only codes. PC/TC indicator 2 of MPFSDB denotes professional component only code identifying stand-alone code
- Example: 93010, Electrocardiogram; interpretation and report. Modifier 26 cannot be used with this code
- Re-read results of interpretation provided by another provider
References