On this page
- What Are Modifier 26 and Modifier TC?
- Which Eye Care Tests Can Be Split Into 26 and TC?
- How Do Global, 26 and TC Billing Compare?
- When Should an Eye Practice Bill Only Modifier 26?
- When Is Modifier TC Used?
- What Is the PC/TC Indicator?
- How Are 26 and TC Billed in Common Eye Care Setups?
- What Must the Interpretation Report Include?
- What Are the Most Common 26 and TC Errors?
- What Else Changes Payment for Eye Tests?
Key takeaways
- Modifier 26 bills the interpretation only, and modifier TC bills the equipment, staff and test only.
- Billing the code with no modifier claims both parts, which is called global billing.
- Most ophthalmic test codes from 92015 to 92287 can be split this way under the Medicare fee schedule.
- For a patient in a hospital or skilled nursing facility, bill only modifier 26.
What Are Modifier 26 and Modifier TC?
Modifier 26 reports the professional component of a diagnostic test, and modifier TC reports the technical component. The professional component is the doctor's interpretation and report. The technical component is the equipment, the technician's time and the supplies used to run the test.
A test billed with no modifier claims both parts at once.
Which Eye Care Tests Can Be Split Into 26 and TC?
Most ophthalmic diagnostic tests can be split, because the Medicare fee schedule gives them a professional and technical component. Most codes in the special ophthalmological services range, 92015 to 92287, carry this split.
These are the eye care tests most often billed with 26 or TC.
- OCT of the optic nerve and retina, 92133 and 92134
- OCT angiography, 92137
- Visual fields, 92081 to 92083
- Fundus photography, 92250
- Fluorescein and indocyanine green angiography, 92235 and 92240
- Corneal topography, 92025
How Do Global, 26 and TC Billing Compare?
Global billing claims the whole test, modifier 26 claims only the reading, and modifier TC claims only the test itself. The table shows who bills each version.
| How it is billed | What it covers | Who bills it |
|---|---|---|
| No modifier (global) | Test and interpretation | A practice that owns the equipment and reads the test |
| Modifier 26 | Interpretation and report only | A doctor reading a test performed elsewhere |
| Modifier TC | Equipment, staff and supplies only | The site that performs the test but does not read it |
When one practice bills both parts on separate lines, the total matches the global payment. The split changes who is paid, not how much is paid in total.
When Should an Eye Practice Bill Only Modifier 26?
Bill only modifier 26 when the doctor interprets a test that another facility performed, including any test on a hospital inpatient or skilled nursing facility patient. The facility is paid for the technical part through its own payment system.
Billing the global code for a facility patient leads to overpayment requests later. The same rule applies when a doctor reads images sent from a screening program or another clinic.
When Is Modifier TC Used?
Modifier TC is used when a site performs a test with its own equipment and staff, but a doctor from another practice reads it. This is common in mobile testing, shared equipment between groups and some co-management setups.
Both practices must agree on who bills which part, because a payer pays each component only once. A written agreement prevents two global claims for the same test.
What Is the PC/TC Indicator?
The PC/TC indicator is a field in the Medicare Physician Fee Schedule that shows whether a code can be split into professional and technical components. Codes with indicator 1 can be billed globally, with modifier 26 or with modifier TC.
Codes with other indicators cannot be split. Exam codes such as 92014 and procedures such as 67028 have no technical component, so adding 26 or TC to them causes a denial. Check the indicator before adding either modifier to a new code.
How Are 26 and TC Billed in Common Eye Care Setups?
The setting and the owner of the equipment decide whether a test is billed globally, with 26 or with TC. The table shows the setups eye practices meet most often.
| Setup | Practice bills | Other party bills |
|---|---|---|
| Practice owns the OCT and its doctor reads it | Global, no modifier | Nothing |
| Test done in a hospital outpatient department, read by the practice doctor | 26 | Hospital bills the facility part |
| Patient is a hospital inpatient or in a skilled nursing facility | 26 | Facility payment covers the technical part |
| Outside imaging or screening program performs the test, practice reads it | 26 | The program bills TC |
| Practice performs the test, an outside specialist reads it | TC | The reading doctor bills 26 |
Each component is paid once. When two parties are involved, agree in writing who bills which part before the first claim.
What Must the Interpretation Report Include?
A test billed with modifier 26, or billed globally, needs a signed interpretation and report from the reading doctor. Without a report, the professional component is not supported.
A complete report usually covers these four points.
- The reason the test was ordered
- The findings for each eye tested
- A comparison with prior tests when they exist
- How the result affects diagnosis or treatment
A printout from the machine is not an interpretation. The doctor's own written findings are what support the professional component.
What Are the Most Common 26 and TC Errors?
The most common errors are billing globally for a facility patient, two parties both billing globally and billing 26 without a written report. Each one leads to a denial or a refund request.
- Global in a facility. Billing the whole test when the facility performed it.
- Double global. Two practices each billing the full test for one scan.
- No report. Billing 26 without a signed interpretation.
- Wrong code type. Adding 26 or TC to a code that cannot be split.
What Else Changes Payment for Eye Tests?
The multiple procedure payment reduction lowers the technical payment for the second and later tests on the same day. CMS pays the test with the highest technical value in full and reduces the technical part of each additional test by 20%.
The reduction applies whether or not 26 and TC are used, so splitting a test does not avoid it. Our ophthalmology medical coding services check each test day for the right component, the right diagnosis and the payer's frequency limits.