Neurology & Pain Management Coding Alert

Question: Our state Medicaid carrier mandates that we bill duplicate charges, such as reporting 95904 twice but with different modifiers (26 and TC). Is there a better way to submit the claims?

Massachusetts Subscriber

Answer: In the example you give, you-re reporting 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory) twice: with modifier 26 (Professional component) and again with modifier TC (Technical component).

Don't worry about billing duplicate services in this case -- you-re not. Appending the modifiers shows that you-re reporting the two components of the service separately instead of submitting a global code: modifier 26 represents the interpretation, and modifier TC shows that your neurologist owns the equipment. Carriers sometimes want you to submit claims this way to distinguish whether your physician or the facility owns the equipment, and therefore should be reimbursed accordingly.