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Issue Number - Name
0051 - Automated Global vs.TC/PC Split Reimbursements
Review Type
Automated
Claim Type
Outpatient Hospital, Physician/Non-physician Practitioner
Region and State
RAC 1-4
All States
Date Approved
2017-04-18

Description

When providers are reimbursed for global procedures and then receive additional reimbursement for technical (modifier TC) and/or profession (modifier 26) components for the same service. 

Affected Code(s)

All applicable CPT/HCPCS codes

Applicable Policy References

Title XVIII of the Social Security Act (SSA), Section 1833(e)

Medicare Fee-for-Service Payment/Physician Fee Schedule PFS Relative Value Files

CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 1, Section 120 

CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 20.2 

CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, Section 20.1, Section 20.2 and Section 20.2.3

CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, Section 80.2.1