Currentpriority healthPolicy N/A

Professional and Technical Components Indicators (PC/TC)

Defines reimbursement and billing rules for services with professional and technical splits using CMS PC/TC status indicators and identifies when modifiers 26 and TC apply; affects providers billing Priority Health for services covered by member benefit plans.

Policy Summary

PayerPriority Health

PolicyProfessional and Technical Components Indicators (PC/TC)

Policy CodePolicy N/A

Change TypeTitle revisionadded disclaimer and CMS reference

Effective DateNov. 11, 2024

Next Review DateFeb. 2027

Key ActionAppend modifier 26 or TC as appropriate for status indicator 1 diagnostic tests to avoid claim denials in hospital inpatient/outpatient settings.

SourceLink

POLICY UPDATE CHANGES

Added 'Disclaimer' section.

Changed policy title from 'Professional and technical components status indicators' to 'Professional and technical components indicators' and added CMS link to references.

9PC/TC categories

Nov 11, 2024Effective

Feb 5, 2025Change - Disclaimer

Feb 18, 2026Change - Title

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.

PC/TC status indicator criteria

Reimbursement and billing criteria by PC/TC status indicator:

Status indicator 0: Physician services not splittable into professional and technical components; examples include office visits, office procedures, surgical services, and injections.

Not splittable into PC/TC

Status indicator 1: Diagnostic tests may be billed globally or split into a professional component (append modifier 26) and a technical component (append modifier TC). Physician services reported in hospital inpatient or outpatient settings (POS 19, 21, 22, 23) should report the professional element; the facility reports the technical component. Claims will deny if the applicable modifier is not reported in these settings.

Payable as professional component; append 26 or TC as appropriate

Status indicator 2: Codes defined as professional component only. Do not append modifier 26 or TC. These services are payable to providers in POS 11, 19, 22, 23, 24, 26, 34, 52, 56, and 61.

Professional-component-only; no 26/TC

Status indicator 3: Codes defined as technical component only. Do not append modifier 26 or TC. These services are not payable to providers for POS 19, 22, 23, 24, 26, 34, 52, 56, and 61 and should be reported by the facility.

Technical-component-only; facility reporting

Status indicator 4: Global services only (include both professional and technical components by code description). Modifiers 26 and TC are not appropriate. These services are not payable to providers for POS 19, 22, 23, 24, 26, 34, 52, 56, and 61.

Global-only; no 26/TC

Status indicator 5: 'Incident to' codes; modifiers 26 and TC are not applicable. These services are performed by auxiliary staff under physician supervision and are not payable to providers for POS 19, 22, 23, 24, 26, 34, 52, 56, and 61.

Incident-to; no 26/TC

Status indicator 6: Clinical laboratory services that allow separate reimbursement to physicians who interpret results. Modifier 26 is appropriate; TC is not appropriate. Lab interpretations are reimbursed under the clinical lab fee schedule and services are payable in facility settings.

Lab interpretation: 26 appropriate; TC not appropriate

Status indicator 7: Services performed by therapists in private practice; these services are not payable in hospital inpatient or outpatient settings when performed by private practice therapists (physical therapy, occupational therapy, speech/language pathology).

Private-practice therapist services not payable in hospital settings

Status indicator 8: Inpatient-only designation for interpretation of abnormal smear results (CPT 85060). Payable only in place of service 21; not payable to outpatient facility or professional settings.

Inpatient-only (POS 21)

Status indicator 9: Professional/technical component concept does not apply to these codes.

PC/TC not applicable

Modifiers and Place of Service

ModifiersModifier

26	Professional Component
TC	Technical Component

Place of service restrictions

POS listed across indicatorsPlaces of service referenced for payable vs not-payable determinations include: 11, 19, 21, 22, 23, 24, 26, 34, 52, 56, 61

POS relevant to Status 1 professional claimsProfessional claims in POS 19, 21, 22, 23 must report the appropriate modifier for diagnostic tests or claims will deny

POS where professional-only codes are payableStatus Indicator 2 codes payable in POS 11, 19, 22, 23, 24, 26, 34, 52, 56, 61

POS where technical-only codes are not payable to providersStatus Indicator 3 technical codes are not payable to providers in POS 19, 22, 23, 24, 26, 34, 52, 56, 61 (reported by facility)

POS where global/other indicators restrict provider paymentStatus Indicator 4 global services and certain other indicators are not payable to providers for POS 19, 22, 23, 24, 26, 34, 52, 56, 61

Modifier and Billing Requirements

Billing Rule

Modifier 26/TC required for Status Indicator 1; missing modifier may cause denial

Append modifier 26 or TC to diagnostic tests assigned PC/TC status indicator 1; when services are reported in hospital inpatient or outpatient settings (POS 19, 21, 22, 23) the professional claim must include the applicable modifier or the claim will deny. CMS updates status indicators quarterly; providers must stay current with those changes.

Status indicator 1 tests may be billed globally or split into professional (modifier 26) and technical (modifier TC) components — append the appropriate modifier.
Physician professional claims in POS 19, 21, 22, 23 must report the professional component modifier; facility reports the technical component.
Claims will deny if the applicable modifier is not reported in these inpatient/outpatient settings.
Monitor quarterly CMS status indicator updates and align billing accordingly.

Key Definitions

Global Services

DefinitionA global service includes both a technical element and professional element within the description of the service.

Components includedGlobal services encompass both equipment/facility/staffing (technical) and physician/provider interpretation/supervision/documentation (professional)

Modifier guidanceFor codes classified as global services, modifiers 26 and TC are not appropriate (use global billing only as defined by the code)

Technical Component

DefinitionA technical component represents the equipment, facility costs and staffing required to perform a service; may be represented with the TC modifier or defined by code.

Billing representationTechnical-only codes are reported with TC or as defined by code; do not append modifier 26 to technical-only services.

Payment reportingTechnical components for services provided in hospitals/facilities are reported by the facility and may not be payable to the provider in specified POS.

Professional Component

DefinitionThe professional component represents the physician or health care provider portion of the service, including supervision, interpretation and documentation of the report.

IdentifierProfessional services are identified by modifier 26 or when the code definition specifies professional services only.

Report contentThe interpretive (professional) report is the written narrative detailing services, treatment, and associated diagnosis.

OpenPayer

Professional and Technical Components Indicators (PC/TC)

PC/TC Status Indicator Criteria

Modifiers and Place of Service

Modifier and Billing Requirements

Key Definitions