Wiki modifers TC and 26

[MaryannR]

I work for an insurance company and have a charge from same provider of service- billing a TC and 26 modifier for CPT codes- 95861;95920;95926;95928;95929.
If I am correctly reading the CPT guidleine, these codes would include physician interpretation. The provider of servic is billing under 2 Tax ID#s- same place of service- and each billed amount is the same for TC and 26. When questioned if it is duplicate- were told ' No, billing for the technical and professional components. Is this correct ?

 

[Bonita Bogan]

Each of the codes listed (CPT codes- 95861;95920;95926;95928;95929) are eligible for the 26 and TC modifiers. However, if the provider billes the global fee utilizing the -00 modifier, then the professional and technical components are included in the global fee.

 

[MaryannR]

So the physician "interpretation" and physician "component" mean 2 seperate concepts?

 

[LRH]

The -TC and -26 represent the 2 components to the procedure: the facility's service of conducting the test, and the physician's service of reading and interpreting the results. In a perfect world, when the fees for both services are added together, they should result in the fee oaid for the global service.