Modifier 26 and TC: who bills which half

The split

Many diagnostic services divide into a technical component — the equipment, supplies and staff who performed the test — and a professional component, the physician’s interpretation and report. Modifier TC bills the technical half. Modifier 26 bills the professional half. No modifier bills both, which is called the global service.

Who bills what, and when

A practice that owns the equipment and whose physician interprets bills globally, with no modifier. A physician interpreting a study performed elsewhere bills 26. A facility that performed the study and sent it out for reading bills TC.

The error that costs most is a practice billing globally for a study it did not perform, or billing TC for equipment it does not own. Both are overpayments, both are found on audit, and both are usually a billing default rather than a decision.

What has to exist for a 26

A written, signed interpretation and report — not a note in a chart saying the study was reviewed. Reviewing a study as part of an evaluation is included in the visit; a separately reportable interpretation is a distinct document with findings and a conclusion.

The places it goes wrong

A study performed in the office and read by an outside radiologist, where both parties bill globally — the claims cross and one denies, usually the practice’s. A hospital-based physician billing TC by default because the billing system defaults there. And services that have no professional and technical split at all, billed with a modifier the code does not accept, which denies as an invalid modifier.

The check worth running

For every diagnostic code the practice bills, answer two questions: do we own the equipment, and does our physician write the report? Two yeses is global. One yes is a modifier. The answers change when equipment is leased or a reading contract begins, and nobody updates the billing rules when they do.