Certain procedures and services have both a professional and a technical component.

• Use modifier 26 when only the professional (physician) component is being billed.
• Use modifier TC when only the technical component is being billed.

Facility outpatient radiology/laboratory claims

In 2016, Priority Health will accept the TC modifier from facilities choosing to report the technical component for services where the professional component is performed by another entity. This modifier should be placed in the next available modifier field, and should not replace any existing modifier hierarchy direction.

Modifier 26 not payable for most lab services

When used with lab services, modifier 26 is a fee for professional interpretation. Per CMS criteria, modifier 26 is not payable with most lab services. See the CMS physician fee schedule payment indicators for more information.

Example of using modifiers 26 and TC

CPT code 95811, Polysomnography, is performed at a Certified Sleep Center. A physician not associated with the sleep center interprets the findings.

• Both providers report on HCFA 1500 forms.
• The physician reports the polysomnography interpretation as 95811-26, the professional component.
• The sleep center reports 95811-TC, the technical component.