26 - JE Part B

Professional Component (PC) 'interpretation' Only (separate from technical component for diagnostic, lab or pathology procedures).

Instructions

• Indicates physician's interpretation or professional component reported separately (from technical component) for diagnostic, lab or pathology procedures
• Check Medicare Physician Fee Schedule (MPFS) Indicator and Descriptor Lists
  • Certain codes are divided from global with TC/26 modifiers
  • Technical and professional component fees equal total global allowance
  • Report in first field as a payment modifier

Correct Use

• Involves global, professional and technical. E.g. 71010, 71010 26 and 71010 TC
• Place of Service (POS) 21, 22 and 23 only
  • Services appended with modifier 26
  • Facility pays technical portion with modifier TC
• If 26 and TC are provided in different service locations (enrolled practice locations), professional and technical must be billed separately

Incorrect Use

• Do not use with evaluation and management (E/M) or Anesthesia codes
• An independent laboratory may not bill TC of a physician pathology service furnished to a hospital inpatient or outpatient
• Cannot use separately if provider performed global service (In this case, no modifier would be necessary)

Claim Coding Example

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 13, Section 20.1 and 150 - Payment Conditions for Radiology Services