HCPCS Modifier TC
Published 07/16/2020
Description
Technical component — HCPCS Modifier TC must be reported for facility charges associated with HCPCS codes that have both a technical and professional component.
Guidelines and Instructions
Refer to the Medicare Physician Fee Schedule database (MPFSDB) to determine if HCPCS modifier TC is applicable to a particular procedure code.
- Special Note for Ambulatory Surgical Centers (ASCs): This modifier must be reported for facility charges associated with HCPCS codes that have both a technical and professional component (e.g., radiology services) under the Medicare Physician Fee Schedule (MPFS)
- This modifier must be submitted in the first modifier field
- Access the database directly from the CMS website
- Select Physician Fee Schedule Search from the left area of the web page
- Screen defaults to current year. Under Type of Information, select Payment Policy Indicators, then Next.
- On the select field options screen, select Next
- Enter the procedure code and select All Modifiers, then click Update Results
- Refer to the column heading PCTC
- Indicator 0: Physician service codes. This indicator identifies codes that cannot be separated into professional and TCs. Examples include visits, consultations and surgical procedures. The concept of PC/TC does not apply since physician services cannot be split into professional components (PC) and TCs. Neither CPT modifier 26 nor HCPCS modifier TC can be submitted with these codes.
- Indicator 1: Diagnostic tests or radiology services. This indicator identifies codes that describe diagnostic tests (e.g., pulmonary function tests or therapeutic radiology procedures like radiation therapy). These codes generally have both a PC and TC. CPT modifier 26, and HCPCS modifier TC may be submitted with these codes.
- Indicator 2: Professional component only codes. This indicator identifies stand-alone codes that describe the physician work portion of selected diagnostic tests for which there is an associated code that describes the TC of the diagnostic test only and another associated code that describes the global test. An example of a PC-only code is CPT code 93010: Electrocardiogram; interpretation and report. Neither CPT modifier 26 nor HCPCS modifier TC can be submitted with these codes.
- Indicator 3: TC-only codes. This indicator identifies stand-alone codes that describe the TC (e.g., staff and equipment costs) of selected diagnostic tests for which there is an associated code that describes the PC of the diagnostic test only. An example of a TC-only code is CPT code 93005: Electrocardiogram; tracing only, without interpretation and report. It also identifies codes that are covered only as diagnostic tests and therefore do not have a related professional code. Neither CPT modifier 26 nor HCPCS modifier TC can be submitted with these codes.
- Indicator 4: Global test only codes. This indicator identifies stand-alone codes for which there are associated codes that describe the PC of the test only, and the TC of the test only. Neither CPT modifier 26 nor HCPCS modifier TC can be submitted with these codes.
- Indicator 5: Incident to codes. This indicator identifies codes that describe services covered incident to a physician's service when they are provided by auxiliary personnel employed by the physician or working under his or her direct supervision. Payment will not be made for these services when they are provided to hospital inpatients or patients in a hospital outpatient department. Neither CPT modifier 26 nor HCPCS modifier TC can be submitted with these codes. For more information on "incident to" guidelines, refer to CMS Pub. 100-02, Chapter 15, Section 60 (PDF, 1.29 MB).
- Indicator 7: Physician therapy service. Payment may not be made if the service is provided to a hospital outpatient or inpatient by an independently practicing physical or occupational therapist
- Indicator 8: Physician interpretation codes. This indicator identifies the PC of clinical laboratory codes for which separate payment may only be made if the physician interprets an abnormal smear for a hospital inpatient. This applies only to CPT code 85060. No TC submission is recognized because payment for the underlying clinical laboratory test is made to the hospital. Note that no payment is made for CPT code 85060 furnished to hospital outpatients or non-hospital patients. The physician interpretation is paid through the clinical laboratory fee schedule payment for the clinical laboratory test. Do not submit HCPCS modifier TC with these codes.
- Indicator 9: Concept of a PC/TC does not apply. Do not submit HCPCS modifier TC with these codes.