Profee and Facility Fee confusion

[Mrsrpc]

Specific to Radiofrequency Ablation/Neurolysis, I'm having trouble reconciling info from different sources around the physician billing and HOPD billing. CPT code 64633. This AAPC article https://www.aapc.com/blog/52001-when-to-apply-modifiers-26-and-tc/
reads:
"A global service includes both professional and technical components of a single service. It is identified by reporting the eligible code without modifier 26 or TC. In such cases, the provider is reimbursed for the equipment, supplies, and technical support, as well as the interpretation of the results and the report. When reporting a global service, no modifiers are necessary to receive payment for both components of the service.

The surest way to identify codes with separate professional and technical components for Medicare payers is to consult the National Physician Fee Schedule Relative Value File, "
The PFS file does not mention TC or 26, and Encoderpro has an n/a next to TC and 26.

I also looked here https://www.cms.gov/cms-guide-medic...rested-parties/payment/physician-fee-schedule

Does this mean that the MD can bill for pro fee using the CPT code 64633 w/out modifier and the HOPD can also bill the same CPT code w/out mod TC and they will each receive their respective fee? Or does that confuse things and look like they are each billing for the same thing?

The whole global billing has always eluded me. Can someone shed some light on this?

 

[catherinetinkey@entmedicalservices.org]

Not every code can be divided TC/26. I believe the code in question is one of those, one provider has to do the global procedure.

 

[sls314]

In general, the PC/TC split is most commonly seen in radiology, pathology, and certain diagnostic testing codes from the medicine section. (For exact details, refer to the RVU file—this is just a general rule of thumb to help build familiarity with the concept.)

For surgical codes, reimbursement follows a different model: the facility is reimbursed under the OPPS (Outpatient Prospective Payment System), while the provider is paid based on a fee schedule. There is no PC/TC split because the facility portion is not included in the fee schedule rate.

A helpful way to understand where the PC/TC split applies is to consider the division of resources: one entity owns the equipment (such as an X-ray machine or pathology lab), while another provides the professional expertise to interpret the results. Modifiers indicate which party is reimbursed for each portion of the service. If the physician owns the equipment, they bill globally (without a modifier) since there is no need to separate the technical and professional components for reimbursement.