Understanding TC Modifier in Medical Billing

The concept of modifiers presents an opportunity to bill the rendered care services more precisely and ensure accurate reimbursement. However, this added specificity comes with many challenges. Whether or not to use a modifier, when to use a modifier, and which modifier to use? All are questions that cloud the minds of healthcare providers and practices alike. 

The misuse and overuse of modifiers can have adverse consequences, such as audits, hefty financial penalties, legal actions, and reputational damage.

Thus, this guide will discuss everything you need to know about an important and commonly used modifier—the TC modifier in medical billing. 

So, without further ado, let’s get started!

What is a TC Modifier?

This modifier explains to the insurance payer that only the technical component of a particular procedure is being billed. This component includes the provision of supplies, equipment, technicians, and other costs related to the performance of a service. Besides, the reimbursement amount for the technical aspects of the procedure includes the malpractice and practice expenses. 

Note that the fee for the technical component of any care procedure is generally reimbursed to the entity or facility providing or paying for the equipment, supplies, and technicians.

Scenarios Where a TC Modifier is Applicable

Let’s look into some modifier TC examples to better understand the proper application of this modifier:

Level IV Surgical Pathology

Assume a modifier TC example where a surgeon removes a suspicious skin lesion and sends the specimen to a pathology laboratory. A pathologist examines the specimen, which involves immunohistochemical staining and microscopic examination. 

Thus, the pathology laboratory will report the CPT code 88305 with modifier TC for processing, staining, microscopic examination of the specimen, and the equipment used. Contrarily, the surgeon will bill only for the professional component of this procedure by appending modifier 26.

Esophageal Motility Study with Stimulation/Perfusion

Let’s say a gastroenterologist requested an esophageal manometry study with pharmacologic stimulation. A technician performed the procedure at the gastroenterology clinic while the gastroenterologist interpreted the findings and generated a report.

Here, the clinic will bill for the technical component, i.e., performing the esophageal manometry study, drug administration, and equipment use by appending the CPT code 91013 with the TC modifier. On the other hand, the gastroenterologist will bill for the professional component of the manometry study separately by reporting the CPT code with modifier 26.

Single View Chest Radiography

What happens when a healthcare practitioner requests a single-view chest X-ray for a patient complaining of a persistent cough? Typically, the radiologist technologist at a hospital performs the X-ray while the physician interprets the results and generates the report.

Thus, the hospital’s radiologist department will report the CPT code 71045 with modifier TC to bill only the technical component. Contrarily, the physician will report the code with modifier 26 to bill for the professional component of the procedure.

Modifier TC – Billing Guidelines

Examples alone are not enough to understand the full scope of the TC modifier. Therefore, here are the billing rules that you must comply with to ensure coding accuracy and appropriate modifier usage. Modifier TC’s appropriate usage will reduce denial rates and lead to higher collections.

Append to Bill the Technical Component of a Service

Append modifier TC when the healthcare provider performs the procedure, but does not interpret the results nor prepares a report.

Do Not Append for Separate Billing in an Institutional Setting

The procedure’s technical component is generally considered institutional. Thus, the physician cannot bill it separately when the patient is inpatient, outpatient, or covered under Medicare Part A with a stay in a skilled nursing facility (SNF).

Append on the First Modifier Field on the Claim

Always report this modifier on the first modifier field of the medical claim since it is a pricing modifier that affects reimbursement.

Refer to the MPFSDB’s PC/TC Column

You can append the TC modifier to procedures having a ‘1’ in the PC/TC column on the Medicare Physician Fee Schedule Database (MPFSDB).

Use for Specifically Identified Procedure Categories/Codes 

You may add modifier TC to procedures that fall under one of these categories: surgery, lab, radiology, medical care/injection, assistant surgeon, and radiation therapy.

Report Professional & Technical Components on Separate Lines 

What happens in scenarios where you have purchased the technical component from an outside entity? You can bill for both components of a specific procedure. How? The physician should report the professional component on one line and the technical component on a separate claim line.

Do Not Use It when the Same Physician Performs Professional and Technical Components

If one physician performed both the technical and professional components of a specific procedure on the same day, avoid appending the TC modifier.

Do Not Append to Procedural Codes with Indicator ‘2’

Do not add this modifier to procedures with the professional component only. You can identify these procedures by checking the PC/TC column on the MPFSDB. If the column has a ‘2’ value, the procedure only contains the professional component.

Do Not Append to Global Service Codes with Indicator ‘4’

Avoid using this modifier with global procedures identified on the MPFSDB with a ‘4’ in the PC/TC column.

Do Not Append to Procedural Codes with Indicator ‘3’

You should not add modifiers that contain only the technical component. On the MPFSDB, these procedures can be identified by a ‘3’ in the PC/TC column.

Modifier TC vs. 26

The table below depicts the key differences between the TC modifier and modifier 26:

	Modifier TC	Modifier 26
What Does It Involve?	Technical component of the procedure (equipment use and personnel’s time and expertise)	The professional component of the procedure (interpretation, medical decision-making, report preparation)
Who Can Bill It?	Entity or facility providing the technical assistance or services for a specific procedure	Physician or qualified healthcare professional

The modifiers 26 and TC are used to distinguish between the professional and technical components of a medical service. However, both modifiers have different applications.

You may append modifier 26 to a procedural code when the clinician performs professional services for a specific care procedure. These may include medical decision-making, interpreting the results, and report preparation. 

A physician or other qualified healthcare professional may report this modifier with a CPT code. For instance, a radiologist may report this modifier with a relevant CPT code for performing the professional component of an MRI scan.

Conversely, a TC modifier in medical billing is used when only the technical service for a specific procedure is being billed. These involve the equipment use and services of a technician. 

Typically, an entity or a facility that provides the technical component, such as the hospital, imaging center, laboratory, etc., may append this modifier. For instance, a hospital may bill the technical component of an electrocardiogram (ECG) by appending this modifier to the relevant CPT code.

Summary

Let’s wrap up this guide by quickly recapping what we learned. We explained that the TC modifier in medical billing is used to bill only the technical services rendered for a specific procedure, such as the equipment usage and technician’s time. Moreover, we shared some scenarios where this modifier is applicable. These included level IV surgical pathology, esophageal manometry, and single-view chest X-ray.

Moving forward, we looked into the billing guidelines for accurately reporting this modifier. Additionally, we discussed the differences between the modifiers 26 and TC. We hope this guide will equip you with the necessary knowledge to up your medical coding and billing game for higher reimbursements and fewer denials related to modifier TC usage.