Can Modifier 26 and TC Be Billed Together?

Medical coding and billing translate healthcare services into standardized codes for administrative and financial processing. Current Procedural Terminology (CPT) codes describe medical, surgical, and diagnostic services. Modifiers add detail to these codes without altering their fundamental meaning. Some diagnostic services comprise distinct professional and technical aspects requiring precise identification for proper reimbursement.

Understanding the Professional Component (Modifier 26)

Modifier 26 signifies the professional component of a medical service. This represents the intellectual input, judgment, and oversight provided by a physician or other qualified healthcare professional, encompassing activities such as supervising a procedure, interpreting diagnostic results, and generating a formal written report. This modifier is appended to a CPT code when the healthcare professional contributes their expertise and analysis. For example, when a radiologist reviews an X-ray image and provides a diagnostic interpretation, their work constitutes the professional component. This ensures payment for the cognitive effort and reporting, distinct from the equipment or personnel acquiring the image.

Understanding the Technical Component (Modifier TC)

The technical component, indicated by Modifier TC, covers the non-physician elements required to perform a medical service. This includes the cost of equipment, supplies, and the time spent by technical personnel. Facilities, such as hospitals or independent diagnostic testing centers, bill for this component. For instance, in an X-ray procedure, the technical component covers the X-ray machine, the film or digital imaging plates, the technician’s time to perform the scan, and the physical space. Billing with Modifier TC ensures that the entity providing the operational aspects of the service receives reimbursement for their resources.

Global Services and Component Billing

Many CPT codes describe a “global service,” which includes both professional and technical components when a single provider or entity performs the entire service. For diagnostic tests, this means the same entity owns the equipment, employs the technical staff, and has the interpreting professional on staff. In global billing scenarios, neither Modifier 26 nor Modifier TC is appended to the CPT code. It is not appropriate to bill Modifier 26 and Modifier TC together on the same service line for the same CPT code, as these modifiers are used to split a global service into its individual parts, not to indicate that both parts were performed simultaneously by the same billing entity. When a global service is divided, for example, a hospital provides the technical component and an independent radiologist provides the professional interpretation, each entity bills for its specific portion using the respective modifier.

When to Use Each Modifier

Proper application of Modifier 26 and Modifier TC depends on who performs and owns the various aspects of a diagnostic service. Modifier 26 is used when a physician or qualified healthcare professional provides only the interpretive or supervisory work for a diagnostic service; this occurs when the technical portion, including the equipment and technical staff, is provided by a separate entity like a hospital or an independent diagnostic facility. For instance, a physician reviewing an ultrasound performed at a hospital would bill with Modifier 26. Modifier TC is utilized when an entity supplies the equipment, supplies, and technical personnel for a diagnostic service, but an outside physician provides the professional interpretation. A freestanding imaging center that performs an MRI scan but sends the images to an external radiologist for interpretation would bill for the technical component using Modifier TC.