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PAP220

CPT Modifiers 26 and TC


Provider Administrative Policy

Section
Claims Submission
Policy Date
December 2006
Status/Date
New/December 2006
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

CPT Modifiers 26 and TC

When services have professional and technical components and you submit a claim for only the professional component of the service, you must apply modifier 26 to the code. When you submit a claim for only the technical component of the service provided, you must apply modifier TC to the code. No modifier is necessary when submitting a claim for both the professional and technical components.When billing for diagnostic tests performed in a hospital setting, only the professional component should be billed. Professional providers should not bill a technical component or global service for diagnostic tests performed in a hospital. A hospital setting could be defined as inpatient, outpatient, emergency room or skilled nursing. (See PAP265


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