Know When to Use Modifier 26 in Medicare Claims

When Medicare procedures have both professional and technical components, modifiers 26 and TC may come into play. You should append modifier 26, “professional component” to a procedure code when you perform only the professional component of the service. Modifier TC, “technical component” designates provision of the technical component of the service.

For example, if a facility performs a test, such as a sleep test, that a physician interprets, the physician bills the procedure code for that service with modifier 26, and the facility bills the same procedure code with modifier TC. 

If, however, a physician provides both the professional component (supervision, interpretation, report) and the technical component (equipment, supplies, and technical support) of a service, that physician would report the global service, i.e., the procedure code without the TC or 26 modifier. This might be the case if an x-ray of a broken bone is taken in the orthopedic surgeon’s office. 

In the first example, if the facility bills the service with the TC modifier but the physician bills it without a modifier, Medicare payer Novitas Solutions would deny the physician’s claim; without modifier 26, the physician appears to be billing for both the technical as well as the professional service he or she performed.

In particular, Novitas reports that it receives a “significant number” of reopening requests to correct claims by adding modifier 26 to services performed in a skilled nursing facility because the physician simply failed to include the modifier. This delays payment to the physician. (Likewise ambulatory surgical centers frequently contact Novitas to add modifier TC to procedure codes that have both a technical and professional component.)

For more information and tips, read this Modifier 26 Fact Sheet on Medicare claims, from Novitas.   

Have coding or billing questions? Contact TMA’s certified coders at (800) 880-1300, ext. 1414, or reimbursementservices[at]texmed[dot]org for answers. If you’d like coding training, or a review of your coding practices, contact TMA Practice Consulting for information at (800) 523-8776 or[at]texmed[dot]org.

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Last Updated On

April 01, 2021

Originally Published On

September 09, 2015

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