CurrentMolina HealthcarePolicy N/A

Use of CPT Modifier TC (Technical Component)

Defines Molina Healthcare's reimbursement guidance for billing the technical component (Modifier TC) of services and how it applies to providers, facilities, and specific service codes.

Policy Summary

PayerMolina Healthcare

PolicyUse of CPT Modifier TC (Technical Component)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionBill Modifier TC when only the technical component of a procedure is provided; do not append TC for global services or when PC/TC indicator is not '1'.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

PC/TC = 1services eligible to bill with Modifier TC

PC/TC = 3technical-only codes (do not append TC)

Hospitals/Facilitiesgenerally do not bill Modifier TC

11/20/2020policy origin

When to Use Modifier TC (Technical Component)

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Modifier TC coverage criteria

Covered when ALL of the following conditions are met:

ALL of the following

Service must have PC/TC indicator = '1' to bill Modifier TC.
Modifier TC may be billed only for services with a value of '1' in the PC/TC Indicator field of the National Physician Fee Schedule (commonly radiology, pathology, laboratory, and certain medicine services).
Do not append Modifier TC to services with PC/TC indicator not equal to '1' (including codes designated technical-only with PC/TC = '3').
Facility and provider billing rules
- Hospitals and other facilities using the UB-04 format generally should not bill Modifier TC; these facilities are assumed to provide the technical component.
- Professional providers may not bill for the technical component of services provided to patients in a hospital or facility setting.
- Portable x-ray suppliers may bill for the technical component of an x-ray performed in certain locations and may also bill for portable x-ray transportation to the location.
If the entire (global) service was performed, do not append either Modifier TC or Modifier 26; no modifier should be used for a global service.

Billing position and examples: when applicable, Modifier TC should be billed in the first modifier position (example: CPT 71045 when PC/TC = 1).

Codes and Coding Rules for Modifier TC

Example CPT codes and applicability of Modifier TCCPT

71045	Radiologic examination, chest; single view — example where Modifier TC should be billed when PC/TC = 1
93005	ECG, routine; tracing only, without interpretation and report — example where Modifier TC does not apply (PC/TC = 3)

PC/TC Indicator requirement

PC/TC indicator requirementModifier TC may be billed only for services with a PC/TC Indicator value of '1' in the National Physician Fee Schedule.

Supported service typesApplies mainly to radiology services and may also include pathology, laboratory, and medicine services when PC/TC = '1'.

Source of indicator valuesPC/TC Indicator values are those listed in the National Physician Fee Schedule.

Billing and Provider Responsibilities

Billing Rule

Billing actions for Modifier TC

Bill Modifier TC when only the technical component of a procedure is provided. Do not append Modifier TC for global services or when the service's PC/TC indicator is not '1'. Hospitals and other facilities using UB-04 generally should not bill Modifier TC; professional providers may not bill the technical component for services provided in a hospital or facility setting.

Only bill TC when the service has a PC/TC indicator value of '1'.
Do not append TC when the global service was performed (do not append TC and 26 together).
Hospitals/facilities billing on UB-04 are assumed to provide the technical component and generally should not bill TC.
Professional providers may not bill the technical component for services rendered in a hospital or facility; portable x‑ray suppliers are an exception and may bill the technical component and transportation when applicable.

Key Terms and Modifier Definitions

CPT Modifier TC

Modifier TC (Technical Component)The cost of the equipment, supplies and personnel to perform the procedure.

Typical billing useUsed when only the technical component of a procedure is provided and the service qualifies (PC/TC = '1').

Distinguishing featuresRepresents non‑professional costs (equipment, supplies, technical staff) separate from interpretation or report generation.

CPT Modifier 26

Modifier 26 (Professional Component)The exercise of medical judgment, including interpretation of results and a narrative report.

Typical billing useAppended when the provider performs the interpretation/analysis and documents findings; separate from technical costs.

Relation to TCRepresents the professional component and is distinct from the technical component billed with Modifier TC.

Global Service

Global ServiceA complete service/procedure where both the technical and professional components are performed by a single provider.

Modifier implicationWhen a global service is performed, neither TC nor 26 should be appended to indicate separation of components.

Billing consequenceGlobal services are billed as a single, combined service rather than separate TC and 26 components.

MAC

MAC (Medicare Administrative Contractor)A private contractor that processes Medicare Part A and Part B medical claims and DME claims for defined jurisdictions and acts as the operational link between Medicare and providers.

RoleAdministers Medicare Part A and B claims for a defined geographic area and supports providers and beneficiaries.

Operational scopeMulti-state, regional contractors responsible for claims processing and program administration within their jurisdictions.

Novitas

Novitas (example MAC)A Medicare Administrative Contractor that handles claims processing and related services for Medicare Parts A and B in Jurisdiction H (JH) and Jurisdiction L (JL).

Contracting authorityContracted by CMS to support healthcare providers and beneficiaries within its jurisdictions.

Scope within policyProvided as a specific MAC example for modifier guidance and claims processing context.