Modifier 26

The professional component of certain procedures and includes the interpretation of results and written reports. Using modifier -26 identifies the professional component.

Modifier TC

The technical component of certain procedures and includes the supply of the equipment, supplies, staff, and costs associated with performing the procedure.

A great example of using these modifiers in ophthalmology is with CPT 76519 and CPT 92136.

• CPT code 76519: ophthalmic biometry by ultrasound echography, A-scan with intraocular lens power calculation.
• CPT code 92136: ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation.

Most radiological testing is split between the professional component and the technical component.  Billing Medicare for the initial test?

• For the initial test bill 92136. When a patient returns for the second eye, bill 92136 -26.
• For the initial test bill 76519, RT or LT.
• If you perform the test for another physician and your office does the technical component, bill 92136 -TC. The referring physician bills 92136 -26 for the interpretation.

The technical component of the test is paid bilaterally, while the professional component is paid per eye. Some non-Medicare carriers don’t recognize the -26/-TC modifier and require -RT or -LT. As always, check your LCD and other payers for specific billing requirements.

Billing with modifiers have you puzzled? The Eye Med Management team stays up to date on ophthalmology billing and coding. Learn how our team can help you avoid costly errors and see increased revenues by contacting us today.