CurrentFlorida BluePolicy 10-014

Professional and Technical Component (PC/TC) Reimbursement

Defines Florida Blue's reimbursement rules for CPT/HCPCS codes that have professional (PC) and technical (TC) components, and explains when modifiers 26 and TC apply for physician and facility billing on CMS-1500 or equivalent claim forms.

Policy Summary

PayerFlorida Blue

PolicyProfessional and Technical Component (PC/TC) Reimbursement

Policy CodePolicy 10-014

Change TypeClarified; References updated

Effective DateNov 30, 2010

Next Review Date

Key ActionWhen reporting professional component only in facility place of service for diagnostic procedures, professional claims should include modifier 26.

SourceLink

POLICY UPDATE CHANGES

Clarifying language added to indicate this policy applies to billing for services on a CMS-1500 or equivalent claim form.

References reviewed and updated during annual reviews through 09/11/2025.

10-014Payment Policy ID

2010-11-30Original effective date

2025-09-11Most recent revision date

CMS-1500Claim form applicability

Professional and Technical Component Reimbursement Rules

PC/TC reimbursement criteria

Florida Blue follows CMS PC/TC indicators to determine reimbursement responsibility between physicians and facilities.

Follow CMS MPFS PC/TC indicators (0–9) to determine applicability of Professional Component (PC) and Technical Component (TC) reimbursement responsibilities between physicians and facilities.

ALL of the following

Indicator 1: Diagnostic tests have both PC and TC. Report PC with modifier 26 and TC with modifier TC.
When provided in a facility place of service (e.g., inpatient/outpatient), the facility is paid the technical component and physicians are reimbursed only for the professional component (report professional claims with modifier 26).
Professional claims for diagnostic procedures submitted with facility POS 19, 21, 22, or 23 should include modifier 26; if submitted without modifier 26 the procedure will be reimbursed for the professional component only.
Exception: Newborn hearing screening codes may be globally reimbursed when the physician or other health care professional owns the equipment and the screen is performed in a facility location.

ALL of the following

Indicator 2: PC-only codes identify stand‑alone physician work codes related to diagnostic tests; modifiers 26 and TC cannot be used with these codes.
Consistent with CMS, Florida Blue allows reimbursement to physicians for indicator 2 codes when reported in a facility place of service.

ALL of the following

Indicator 3: TC-only codes identify stand‑alone technical component codes (staff and equipment). Modifiers 26 and TC cannot be submitted with these codes.
These codes have no physician work and are not payable to the physician when performed in a facility but may be paid to the facility; when billed in the office they are payable to the physician.

ALL of the following

Indicator 4: Global test only codes are stand‑alone codes for which separate PC and TC codes exist; modifiers 26 and TC cannot be used.
Florida Blue will not reimburse the physician when these codes are rendered in a facility POS; when billed in the office they are payable to the physician.

ALL of the following

Indicator 5: Incident‑to codes describe services provided by auxiliary personnel under direct physician supervision and are intended to be billed incident to a physician's service.
Modifiers 26 and TC cannot be used with these codes; Florida Blue will not reimburse physicians for indicator 5 codes when reported in a facility (inpatient or hospital outpatient).

ALL of the following

Indicator 6: Laboratory physician interpretation codes may be separately paid for interpretive services; modifier TC cannot be used.
Florida Blue will allow reimbursement to physicians for indicator 6 clinical laboratory interpretive services provided in a facility POS and these codes may be reported with modifier 26.

ALL of the following

Indicator 8: Physician interpretation codes for clinical laboratory (example CPT 85060) are payable only for specified inpatient interpretations.
Florida Blue will not reimburse code 85060 when reported with a place of service other than inpatient hospital (POS 21).

Modifiers, PC/TC Indicators, and Code Guidance

PC/TC ModifiersCPT | HCPCS

26	Professional Component (modifier)
TC	Technical Component (modifier)

PC/TC Indicator categories (description references)mixed

0	Physician Service Codes (PC/TC concept does not apply; modifiers 26 and TC cannot be used).
1	Diagnostic Tests (have both PC and TC; PC reported with modifier 26 and TC reported with modifier TC; facility paid TC, physician paid PC with modifier 26).
2	Professional Component Only Codes (stand-alone professional codes; modifiers 26 and TC cannot be used).
3	Technical Component Only Codes (stand-alone technical codes; modifiers 26 and TC cannot be used; not payable to physician in facility but may be paid to facility; payable to physician when billed in office).
4	Global Test Only Codes (global test codes; modifiers 26 and TC cannot be used; Florida Blue will not reimburse physician when rendered in a facility POS; payable to physician when billed in the office).
5	Incident to Codes (services provided incident to physician by auxiliary personnel under direct supervision; not payable when provided to hospital inpatients or in hospital outpatient departments; modifiers 26 and TC cannot be used).
6	Laboratory Physician Interpretation Codes (separate payment for lab interpretations may be made; modifier TC cannot be used; may be reported with modifier 26 and reimbursed in facility POS consistent with CMS).
7	Physical Therapy Service (certain CPT/HCPCS codes specific to privately practicing therapists; payment may not be made if provided to hospital outpatients or inpatients by private-practice therapists).
8	Physician Interpretation Codes for lab (separate payment allowed only for specified inpatient interpretations; Florida Blue will not reimburse code 85060 when reported with POS other than inpatient hospital POS 21).
9	Not Applicable (PC/TC concept does not apply).

PC/TC Indicator set

PC/TC indicator setCMS MPFS Professional Component/Technical Component (PC/TC) indicators 0-9 used to determine whether a CPT/HCPCS code is physician-only, diagnostic with PC & TC, PC-only, TC-only, global-only, incident-to, lab interpretation, therapist service, physician interpretation only, or not applicable.

Source guidanceFlorida Blue aligns reimbursement responsibility between physicians and facilities with CMS MPFS PC/TC indicators; applies to billing on a CMS-1500 or equivalent claim form.

ApplicabilityUsed to determine when modifiers 26 (PC) and TC (technical) are appropriate and whether services are payable to physician or facility.

Billing and Provider Requirements

Note

Authorization/Guarantee Disclaimer

THIS PAYMENT POLICY IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. All medical decisions are the sole responsibility of the patient and physician. Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. This payment policy applies to all lines of business and providers of service and does not address all potential issues related to payment for services provided to Florida Blue (BCBSF) members. Legislative mandates, provider contract documents, or the member's benefit coverage may supersede this policy.

Billing Rule

Modifier 26 usage for facility POS

When reporting only the Professional Component (PC) for diagnostic procedures provided in a facility place of service, submit the professional claim with modifier 26 appended to the usual procedure number (or use the stand‑alone code identifying the professional component when applicable). The Technical Component (TC) or global service should not be reported on the professional claim when modifier 26 is used.

Applies to CPT and HCPCS codes where PC/TC distinctions exist
Use modifier 26 for Professional Component only billing in facility POS

Key Terms and Component Definitions

Global Service

DefinitionGlobal Service includes both a Technical Component (TC) and a Professional Component (PC); reporting the procedure code with no modifier typically identifies the Global Service.

ReportingWhen reported separately, PC is identified with modifier 26 or a standalone PC code and TC is identified with modifier TC or a standalone TC code.

Policy scopeThis policy describes reimbursement for CPT and HCPCS codes based on CMS MPFS PC/TC indicators and applies to CMS-1500 or equivalent claim forms.

Technical Component (TC)

DefinitionTechnical Component (TC) represents the technician, equipment and facility costs required to perform the procedure.

ReportingWhen reported separately, TC is identified by adding modifier TC to the procedure code or by reporting a standalone TC-only code.

Payment allocationWhen services are hospital inpatient or outpatient, the facility should report the technical component and is reimbursed for it; physicians are reimbursed only for the PC.

Professional Component (PC)

DefinitionProfessional Component (PC) represents the physician or other healthcare professional work portion, including supervision and interpretation that results in a written report contributing to diagnosis or treatment.

ReportingWhen reported separately, PC is identified by adding modifier 26 to the procedure code or by reporting a standalone PC-only code.

Reimbursement contextPhysicians and other healthcare professionals may be reimbursed for PC when billed appropriately (e.g., modifier 26) even if the facility is paid for the TC.

PC/TC Indicator (CMS MPFS 0-9)

Indicator 0Physician service codes — PC/TC concept does not apply; modifiers 26 and TC cannot be used.

Indicator 1Diagnostic tests — codes comprise PC and TC; report PC with modifier 26 and TC with modifier TC; facility POS: facility paid TC, physician reimbursed for PC (report with modifier 26).

Indicator 2Professional-component-only codes — standalone PC codes; modifiers 26 and TC cannot be used; reimbursable to physicians consistent with CMS when reported in facility POS.

Indicator 3Technical-component-only codes — standalone TC codes describing staff and equipment; not payable to physician in facility but may be paid to facility; payable to physician when billed in the office.

Indicator 4Global test-only codes — standalone codes with associated PC-only and TC-only codes; not reimbursed to physician when rendered in facility POS; payable to physician when billed in the office.

Indicator 5Incident-to codes — services provided by auxiliary personnel under direct supervision; not payable when provided to hospital inpatients or in hospital outpatient departments; modifiers 26 and TC cannot be used.