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Issue Number - Name
0116-Improperly Paid Modifiers TC and 26
Review Type
Automated
Claim Type
Professional Services (Physician/Non-Physician Practitioner
Region and State
RACs 1-4
All A/B MACs
Date Approved
2018-10-09

Description

HCPCS Codes with a PC/TC Indicator of "1" and billed with either 26 or TC in any modifier field should be paid at either the technical component or the professional component rate based on the modifier billed.  Overpayments occur when the applicable Medicare Physician Fee Schedule amount for Modifier TC and/or 26 are not applied.

Affected Codes

HCPCS Codes with a PC/TC Indicator of "1" as identified in the CMS MPFSDB

Applicable Policy References

Social Security Act: Section 1833(e)

CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 23; Addendum - MPFSDB Record Layouts  20 - Professional Component (PC)/Technical Component (TC) Indicator

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c23.pdf