26 Modifier (Professional Component)
When the physician component is reported separately, the 26 modifier must be added to the procedure code. The payment includes the physician’s work, practice expense and malpractice expense.
TC Modifier (Technical Component)
When the technical component is reported separately, the TC modifier must be added to the procedure code. The payment does not include any physician work Relative Value Units (RVUs). Refer to the section “Physician Supervision of Diagnostic Tests” for complete information on requirements for physician supervision for the technician who may actually perform the tests.
Repeat Radiological Procedures (Modifiers 76 and 77)
Radiologists should use the following modifiers when an X-ray procedure is being repeated on the same day:
76 Modifier Repeat procedure by same physician
The physician may need to indicate that a procedure or service was repeated subsequent to the original procedure or service. This circumstance may be reported by adding the 76 modifier to the repeated procedure/service.
77 Modifier Repeat procedure by another physician
The physician may need to indicate that a basic procedure or service performed by another physician had to be repeated. This situation may be reported by adding the 77 modifier to the repeated procedure/service.
These modifiers will help Medicare identify that the services are not duplicate billing problems but medically necessary repeat procedures.
Please be aware that the second reading of the same X-ray is considered an over-read and is not a covered service under Medicare. Do not use a 76 or 77 modifier when billing for the second reading of an X-ray.
50 Modifier (Bilateral Procedures)
The 50 modifier is valid with certain diagnostic procedures and, when reported with those procedures, will be reimbursed at the full Medicare fee schedule for each site or organ or site of a paired physiological entity.
To obtain proper reimbursement for bilateral procedure, report a 50 modifier and a quantity of one. TrailBlazer will not process a quantity of more than one.
When the physician component is reported separately, the 26 modifier must be added to the procedure code. The payment includes the physician’s work, practice expense and malpractice expense.
TC Modifier (Technical Component)
When the technical component is reported separately, the TC modifier must be added to the procedure code. The payment does not include any physician work Relative Value Units (RVUs). Refer to the section “Physician Supervision of Diagnostic Tests” for complete information on requirements for physician supervision for the technician who may actually perform the tests.
Repeat Radiological Procedures (Modifiers 76 and 77)
Radiologists should use the following modifiers when an X-ray procedure is being repeated on the same day:
76 Modifier Repeat procedure by same physician
The physician may need to indicate that a procedure or service was repeated subsequent to the original procedure or service. This circumstance may be reported by adding the 76 modifier to the repeated procedure/service.
77 Modifier Repeat procedure by another physician
The physician may need to indicate that a basic procedure or service performed by another physician had to be repeated. This situation may be reported by adding the 77 modifier to the repeated procedure/service.
These modifiers will help Medicare identify that the services are not duplicate billing problems but medically necessary repeat procedures.
Please be aware that the second reading of the same X-ray is considered an over-read and is not a covered service under Medicare. Do not use a 76 or 77 modifier when billing for the second reading of an X-ray.
50 Modifier (Bilateral Procedures)
The 50 modifier is valid with certain diagnostic procedures and, when reported with those procedures, will be reimbursed at the full Medicare fee schedule for each site or organ or site of a paired physiological entity.
To obtain proper reimbursement for bilateral procedure, report a 50 modifier and a quantity of one. TrailBlazer will not process a quantity of more than one.