You might have seen modifiers TC and 26 quite a lot in medical billing. But do you understand what they are used for? Many services are divided into professional and technical components. While it is quite easy to bill for a service completely performed by the same provider, what happens if different people are involved?
They obviously need to be compensated individually for their time and expertise. Modifier TC makes this possible. However, many people face denials and serious consequences for using it incorrectly. It is okay to be confused and unsure about this modifier. However, we guarantee that you won’t be making the same mistake because today we will discuss the TC modifier in quite detail.
Modifier TC – Description
The TC modifier is quite simple. It specifies the technical component of a service, usually a diagnostic test. But what does the technical component mean, and who can use this two-digit code? The technical component of a service is basically facility costs, including equipment and supplies, clinical support, and maintenance.
In simple terms, it is the use of equipment by a facility or hospital during a test. Hence, modifier TC is primarily used by facilities to bill for their part when some procedural codes involve both professional and technical elements.
Appropriate Use Cases for Modifier TC
The only way to receive proper payment for your equipment or technical staff is to understand the appropriate use modifier TC. That’s why we have highlighted the following two examples:
Billing for Technical Support During a Simple Cystometry
Urodynamic studies have real clinical value as they help diagnose many conditions, including urinary incontinence. Since this condition affects more women (75 to 80% to be exact) than men in the U.S., let’s consider a middle-aged woman.
She arrives at a hospital due to continuous urine leakage during certain movements or activities, especially coughing. A hospital technician performs a simple cystometry on a healthcare provider’s order. The facility then appends modifier TC to CPT code 51725 to bill for their support.
Reporting the Technical Component of the Mastoid Cavity X-Ray
Although mastoiditis (infection of the mastoid bone) is a rare condition in the U.S., it mostly affects toddlers. Therefore, let’s suppose a mother brings her distressed toddler to a specialized diagnostic imaging center for an X-ray of the mastoid cavity.
The child’s ENT specialist ordered the test after noticing drainage from his right ear and swollen skin behind it. The technician performs the test and sends the report to the otolaryngologist for interpretation. The imaging facility reports this service by applying modifier TC to CPT code 70120.
Accurate Usage Guidelines for Modifier TC
Every healthcare provider and facility must break down their services clearly and comply with billing regulations, including the correct use of modifiers. You cannot apply modifier TC to every scan or imaging study. That’s why you should learn the following do’s and don’ts of this code.
Appropriate Use of Modifier TC
You should only use the modifier TC to:
- Bill for the technical aspect of a test.
- Procedural codes that have “1” in the PC/TC field on the Medicare Physician Fee Schedule (MPFS) database.
- Report the technical aspect of a procedure performed by an independent technician or the equipment provided by an outside supplier.
In the last point’s case, the provider should bill the professional component with modifier 26 on one line and report the TC modifier on another line.
Inappropriate Use of Modifier TC
On the other hand, avoid adding modifier TC to:
- Procedural code where the same healthcare provider has performed both professional and technical components on the same day.
- Pre-specified professional component only procedural codes (They are indicated by “2” in the PC/TC column)
- Codes that only represent the technical component of a service (They have a “3” in the PC/TC field)
- Global test-only procedural codes, marked by a “4” in the PC/TC column on MPFS.
Can You Bill Modifier TC and 26 Together?
No! Modifiers TC and 26 are technically mutually exclusive. Hence, you cannot bill them together on the same claim line.
Modifier TC
As you may already know, modifier TC represents the technical part of a service. In simple terms? The use of equipment, supplies, and the involvement of technical staff. As a result, it is usually billed by a facility.
Modifier 26
On the other hand, modifier 26 specifies the professional component, the interpretation and reporting of a test. Hence, healthcare providers usually use this code to request reimbursement for their time and expertise.
Why Should You Avoid Billing TC and 26 Together?
The answer is quite simple. Both modifiers highlight different people involved in a service. Hence, it would be contradictory to use them together. But what if the same healthcare provider has performed both components? In that case, he should use a global service code.
Final Thoughts
Modifier TC is important for receiving appropriate reimbursements. It helps insurance payers identify who performed the technical part of the service and reimburse them accordingly. Unfortunately, many people use this two-digit code with pre-specified professional or technical component codes.
This eventually leads to payment denials and reputational damage. To help you avoid this billing hiccup, we have explained everything you need to know about the TC modifier. So, use this modifier with confidence and receive complete payment for your services.
