When CPT procedure codes are valued, they typically include the physician or qualified healthcare professional (QHP)’s professional time, as well as the time spent by non-physician personnel to render the test, facility expense, equipment, and supplies. This is considered a global code.
There are some diagnostic codes that only account for the professional work of the physician or QHP to interpret the procedure results and prepare the report (e.g. 93010 – Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only). There are other codes that refer only to the technical aspects of the code (e.g. 93005 – Electrocardiogram, routine ECG with at least 12 leads; tracing only; without interpretation and report).
There are some diagnostic codes that can be reported on the claim in one of two ways: either as a global code, or as a split code for either the professional component or the technical component of the work. This is accomplished by appending either the 26 (professional component) modifier or the TC (technical component) modifier to the procedure or service on the claim, as applicable. The 26 or TC modifier will alert the insurance company which portion of the procedure to reimburse to which billing entity.
Professional Component (Modifier 26)
The professional component is reported to indicate that a physician or other qualified healthcare professional (QHP) has rendered only the professional component of the service. The professional component includes the work of the analyzing and interpretating the results, the recommendations, and the written report.
Technical Component (TC Modifier)
The technical component addresses the non-physician medical staff time, use of equipment, and supplies, but does not include the physician/QHP professional time.
Billing Professional and Technical Components In a Facility-Based Setting
In a facility-based setting that owns the equipment, the TC component is billed by the facility for the procedure. The PC component (26 modifier) can also be billed by the physician/QHP for the professional time to analyze, interpret or read the test and write the report.
A description of these modifiers is presented in Table 1. A list of audiology codes eligible for split-billing of PC and TC components is presented in Table 2. The modifier reflects whether it is the technical component (-TC) or professional component (-26). Reporting the code without a modifier indicates the global value (both technical and professional component) for billing purposes.
Table 1. Professional and Technical Component Modifiers, Descriptions, and Examples
| Modifier | Descriptor | Definition | Example |
| -26 | Professional Component | Certain procedures allow for reporting the professional component or technical component separately. When the professional component is reported separately, add the modifier -26 in box 24D on the claim form. | The physician/audiologist does not administer the test but reads, interprets the test results and writes the report. |
| -TC | Technical Component | When the technical component is reported separately, add the modifier -TC in box 24 on the claim form. | The audiologist performs the test but does not read, interpret or write the report. |
| Note: Reporting without the -26 or -TC modifiers, implies the entire service was provided by the billing entity. | |||
Table 2. List of Audiology Codes Eligible for Use of the Professional and Technical Components
| CPT Code | Description |
| 92537 | Caloric vestibular test with recording; bilateral, bithermal |
| 92538 | Caloric vestibular test with recording; bilateral, monothermal |
| 92540 | Basic vestibular evaluation; includes spontaneous nystagmus test, positional nystagmus test (minimum of 4 positions), optokinetic nystagmus test, oscillating tracking test, all with recording |
| 92541 | Spontaneous nystagmus test, with recording |
| 92542 | Positional nystagmus test; minimum of 4 positions, with recording |
| 92544 | Optokinetic nystagmus test, with recording |
| 92545 | Oscillating tracking test, with recording |
| 92546 | Sinusoidal vertical axis rotational testing |
| 92548 | Computerized dynamic posturography, sensory organization test (CDP-SOT) |
| 92549 | Computerized dynamic posturography, sensory organization test (CDP-SOT) with motor control test (MCT) and adaptation test (ADT) |
| 92587 | Distortion product evoked otoacoustic emissions; limited evaluation, 3-6 frequencies, with interpretation and report |
| 92588 | Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation, minimum of 12 frequencies, with interpretation and report |
| Note: Global service billing would be completed using the applicable CPT code without a modifier, indicating that the entire service was provided by the billing entity. Separate reporting of the professional component (PC) and technical component (TC) would be completed by appending the -26 modifier for the PC and the -TC modifier for the TC (see Table 1). | |
Services Provided by Audiologists
The PC of a PC/TC split code can be billed by an audiologist, physician, or other non-physician provider (NPP) who personally provided the service in either a facility or non-facility setting. Physicians or other NPPs may bill for the PC when audiologists only perform the TC of the service. However, physicians or other NPPs may not bill the PC when the professional services were provided by an audiologist.
Services Provided by Technicians
The TC of a PC/TC split code can be billed by an audiologist, physician or other NPP who personally provided the service in either a facility or non-facility setting. Physicians can report the TC modifier when the service was provided by a technician that was supervised by the physician. Audiologists and NPPs may not report the technical portion of a service that was provided by a technician.
Conclusion
Audiologists are encouraged to reference primary resources from the Centers for Medicare and Medicaid Services to identify other relevant information related to the correct reporting for professional and technical components in facility settings. Other considerations may be hospital- or department-dependent, and practitioners are encouraged to consult with billing departments to determine reporting procedures that are most appropriate for their practice setting.
Need more help? Contact us at reimbursement@audiology.org.
Resources and References from the Centers for Medicare and Medicaid Services
Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners. (March 2024). https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
Facility versus Non-Facility Reimbursement: Incorrect Coding. (2018). https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Approved-RAC-Topics-Items/0108-Facility-vs-Non-Facility-Reimbursement
Centers for Medicare and Medicaid Services (CMS). Status Indicators. (May 2024).
https://www.cms.gov/status-indicators
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Disclaimer:
The purpose of the information provided by the American Academy of Audiology Coding and Reimbursement Committee is strictly for educational guidance to audiologists. Action taken with respect to the information provided is an individual choice. The American Academy of Audiology hereby disclaims any responsibility for the consequences of any action(s) taken by any individual(s) as a result of using the information provided, and reader agrees not to take action against, or seek to hold, or hold liable, the American Academy of Audiology for the reader’s use of the information provided. As used herein, the “American Academy of Audiology” shall be defined to include its directors, officers, employees, volunteers, members, and agents.
