Wiki Adjust price when billing with modifier TC?

[kimberagame]

Hello all!

I work for a family medicine clinic. We're frequently billing x-rays with both the technical and professional component. But sometimes we send them for overreads, in which case we only bill the technical component. We've never adjusted down our price when billing with modifier TC, believing that the modifier will automatically trigger the payer to adjust the price as appropriate.

We're in the process of switching EMRs, and need to give the new EMR company our fee schedule to populate the program. Any charge that could have a modifier that will change the price of a service needs to be listed on the fee schedule both without the modifier at the normal price, and with the modifier at the adjusted price. I was told to be sure to include modifier TC for our x-rays. Should we be sending out our claims with a reduced price for x-rays that have modifier TC?

Thanks for any input!

 

[thomas7331]

It would make sense to charge a different prices because the code without the modifier includes two services whereas with the modifier is only one service. But you’re not required to do so. For your contracted payers it might not make any difference anyway because, as you’ve said, they will pay according to the fee schedule and not your charge. But for non-contracted payers and self pay patients, if you’re charging the same for both, you’re basically including the professional component for free (or charging the patient for the professional service they didn’t get, depending on how you look at it).