Using modifiers TX and 26 in billing medical claimsThese modifiers identify the “professional” and the “technical” components of services that combine both portions into one procedure code.
-TC is the technical component.
-26 is the professional component.
Medicare Part B Jurisdiction 8 (WPS) offers this additional information on appropriate and inappropriate use of these modifiers:
• To bill for only the technical component of a test
• Procedures that have a "1" in the PC/TC field on the MPFSDB
• Procedures falling into the following types of service;
2 - Surgery
5 - Lab
8 - Assistant Surgeon
1 - Medical Care/Injections
4 - Radiology
6 - Radiation Therapy
• Used when billing both the professional and technical component of a procedure when the technical component was purchased from an outside entity. The provider would bill the professional on one line of service and the technical on a separate line.
• Do not submit the technical component separately when one physician performs both the professional and technical components on the same day.
• Appending it to:
• Professional component only procedure codes identified on the MPFSDB by a "2" in the PC/TC column
• Global test only procedure codes identified on the MPFSDB by a "4" in the PC/TC Column
• Technical component only procedure codes identified on the MPFSDB by a "3" in the PC/TC column
• Modifier 26 and TC are considered payment modifiers and must be reported in the first modifier field
• Code the procedure without modifiers when performing a global service. Do not report a procedure code with both modifiers 26 and TC
• The payment for the technical component portion of a test includes the practice expense and the malpractice expense
• Technical component procedures are institutional and cannot be billed separately by the physician when the patient is an inpatient, outpatient, or in a covered Part A stay in a skilled nursing facility (SNF) location.