Total Procedures Billed Separately

(1) Certain diagnostic procedures (neurological testing, radiology and pathology procedures, etc.) may be performed by two separate entities that also bill separately for the professional and technical components. When this occurs, the total reimbursement shall not exceed the maximum medical fee schedule allowable for the procedure code listed. (a) When billing for the professional component only, modifier 26 (Professional Component) shall be added to the appropriate procedure code. (b) When billing for the technical component only, modifier TC (Technical Component) is to be added to the appropriate procedure code.