Modifier 26 and TC

Some services have two halves. An MRI is a machine, a technologist and a room, and it is also a radiologist sitting down to read the images and write a report. Billing splits those halves with two modifiers on the same CPT code. Modifier 26 marks the professional component, which is the doctor's interpretation. Modifier TC marks the technical component, which is the equipment and the staff. Billed together without either modifier, the code is called the global service, and the price covers both.

This is why an imaging price can look right and still be half a price. A brain MRI, CPT 70553, might show a negotiated rate of $95 in a carrier file. That is the radiologist's read, modifier 26. The technical component at the same hospital might be $1,400, and the global rate about $1,500. If a price comparison tool grabs the $95 line and calls it the price of an MRI, it has quietly left out 94 percent of the bill. I've seen this mistake made by people who should know better. The same split shows up on EKGs, echocardiograms, pathology and sleep studies. Cash imaging centers in Texas usually quote the global price, with the read included, which is one reason a $359 cash MRI is a real number and a $95 network rate for the same scan is not.

The takeaway: when you see a price for any imaging or test, ask whether it includes the read. If a bill has a 26 or a TC on the line, a second bill exists somewhere.