CurrentAnthemPolicy C-20004

Modifier 26 and TC: Professional and Technical Component

Defines Anthem's reimbursement rules for billing the professional (Modifier 26) and technical (Modifier TC) components of procedures for commercial members, including when global, professional, or technical components are eligible for reimbursement and facility-related restrictions.

Policy Summary

PayerAnthem

PolicyModifier 26 and TC: Professional and Technical Component

Policy CodePolicy C-20004

Change TypeNo material change

Effective DateJan 1, 2026

Next Review Date

Key ActionBe prepared for post-payment review and provide additional documentation upon request to avoid potential recoupment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

global allowedGlobal allowed when both components by same provider

not allowed on E/M26 and TC not allowed on E/M codes

facility TCFacility-only TC reimbursement

portable suppliersPortable x-ray suppliers bill TC

Reimbursement for Professional and Technical Components

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Reimbursement criteria for Modifier 26 and TC

When and how Anthem reimburses professional and technical components:

ALL of the following

Professional component
- Modifier 26 indicates the professional component and is reimbursable when billed separately by the physician or other qualified health care professional.
Technical component
- Modifier TC indicates the technical component and is reimbursable when billed separately to the facility.
Portable x-ray suppliers should bill only for the technical component by appending modifier TC.

ALL of the following

If no modifier 26 or TC is present and the same physician or other qualified health care professional performed both the professional and technical components, the global procedure is reimbursable.
When one provider reports a global procedure and a different provider reports the same procedure with a professional or technical component modifier for the same patient on the same date of service, the first charge approved by the health plan is eligible for reimbursement; subsequent charges are considered duplicate and are not eligible for separate reimbursement.

ALL of the following

The global procedure or technical component will not be reimbursed to a physician when services are performed in specified facility places of service (examples include Off Campus-Outpatient Hospital [19], Inpatient Hospital [21], On Campus-Outpatient Hospital [22], Emergency Room - Hospital [23], Ambulatory Surgical Center [24], Inpatient Psychiatric Facility [51], Comprehensive Inpatient Rehabilitation Facility [61]).

ALL of the following

Modifier 26 or Modifier TC is not reimbursable when reported on an Evaluation and Management (E/M) code.
Modifier 26 or Modifier TC is not reimbursable when there is a separate standalone code that describes the professional component only, technical component only, or global test only of a selected diagnostic test.
The health plan reserves the right to perform post-payment review of claims submitted with modifier 26 or modifier TC and may request additional documentation; failure to provide requested documentation may result in recoupment or recovery of previously paid amounts.

ALL of the following

A physician or other qualified health care professional may be reimbursed only for the professional component when the facility is reimbursed for the technical component; the physician should make arrangements with the facility for reimbursement for performance of any technical components, if applicable.

ALL of the following

Global Procedure: represents both the professional and technical component as a complete procedure or service; reported without modifier 26 or TC.
Professional Component (Modifier 26): the portion representing the physician's work, interpretation, and report; billed by adding modifier 26.
Technical Component (Modifier TC): the portion representing equipment, supplies, technical personnel and institutional costs; billed by adding modifier TC and generally reimbursed to the facility.

Modifier and Coding Rules

Covered ModifiersModifierCovered

Modifier 26	Denotes the professional component when billed separately
Modifier TC	Denotes the technical component when billed separately

Non-reimbursable Uses / RestrictionsModifierNot Covered

Modifier 26	Not allowed when reported on Evaluation and Management (E/M) codes or when a stand-alone code describes the component
Modifier TC	Not reimbursable to physicians when services are performed in a facility defined in Related Coding; only the facility may be reimbursed for the technical component

Facility / Portable X-ray GuidanceModifierCovered

Modifier TC	Portable x-ray suppliers should bill only for the technical component by appending modifier TC
Modifier 26	Physician may be reimbursed only for the professional component when technical component is facility responsibility; physician should arrange reimbursement with facility for any technical components they perform

Non-reimbursable uses

E/M codesModifier 26 and Modifier TC are not reimbursable when reported on an Evaluation and Management (E/M) code.

Stand‑alone codesNot reimbursable when a separate stand‑alone code exists that describes the professional component only, technical component only, or global test only.

Post‑payment review consequenceUse of Modifier 26 or TC may trigger post‑payment review; failure to provide requested documentation can result in recoupment.

Documentation and Post-Payment Review

Documentation Required

Documentation and post-payment review — retain and produce records or risk recoupment

Be prepared for post-payment review and to provide supporting documentation upon request. If documentation requested during a post-payment review is not provided, the health plan may recoup or recover monies previously paid on the claim.

Retain medical records and billing documentation that fully support the use of Modifier 26 or Modifier TC.
Respond to health plan requests for additional documentation in a timely manner per contractual obligations to avoid recoupment.

Key Definitions

Global Procedure

DefinitionGlobal procedure represents both the professional and technical component as a complete procedure and is identified by reporting the eligible procedure without Modifier 26 or TC.

When allowedIf the same physician or provider performed both components and no modifier is present, the global procedure is eligible for reimbursement.

Duplicate billingIf multiple providers bill the same procedure on the same date, the first approved charge is eligible and subsequent charges are considered duplicate and not separately reimbursed.

Professional Component (Modifier 26)

DefinitionProfessional Component (Modifier 26) is the portion of the service representing the physician's (or other practitioner's) work, including interpretation and report; identified by adding modifier 26 when billed separately.

Who billsBilled by the physician or other qualified health care professional when the professional work is reported separately.

Separate from institutional chargesThis component is usually charged and billed separately from inpatient hospital (institutional) charges.

Technical Component (Modifier TC)

DefinitionTechnical Component (Modifier TC) identifies the provision of equipment, supplies, technical personnel, and institutional costs attendant to performance of the procedure; billed by adding modifier TC when reported separately.

Facility reimbursementTechnical component charges are institutional charges generally reimbursed to the facility and not billed separately by physicians.

Portable x‑ray suppliersPortable x‑ray suppliers should bill only the technical component and must utilize modifier TC; their charge data are used for customary and prevailing profiles.

Stand-alone Code

DefinitionStand‑alone code describes the professional component only, technical component only, or global test only of a selected diagnostic test.

Modifier usageModifier 26 and Modifier TC should not be used with a stand‑alone code.

ImplicationWhen a stand‑alone code exists, separate billing with modifier 26 or TC for that component is not allowed under the policy.