Modifier TC

The technical component pays for producing a test rather than interpreting it. For codes that split, the fee schedule prices that part on its own, and modifier TC tells the payer the line covers only the performing side: the scanner or monitor, the staff who run it and the supplies used. It is the counterpart of modifier 26. When one entity bills TC and another bills 26 for the same study, the two lines together make up the global service.

Who may bill it depends on where the patient was. Medicare does not pay a physician or supplier for the technical component of radiology services furnished to hospital patients; that payment goes to the hospital as a provider service. For a skilled nursing facility resident in a covered Part A stay, consolidated billing puts the technical component on the facility’s claim. In a physician’s office, a freestanding imaging or radiation oncology center, or any other setting that is not part of a hospital, the technical component is paid under the fee schedule.

Two rules catch practices out. Medicare’s common working file compares supplier claims for the technical component with hospital inpatient claims, and when a TC line falls between the admission and discharge dates, the contractor adjusts it and recoups the payment. And under the anti-markup rule, a practice that orders a diagnostic test and bills a technical component it bought from an outside supplier it does not share a practice with is paid the lowest of the supplier’s net charge, its own charge or the fee schedule amount, and it must identify the performing supplier on the claim.