What do modifiers 26 and TC mean, and which one goes on your claim?
Modifier 26 marks the professional component of a diagnostic test, the physician's interpretation and written report. Modifier TC marks the technical component, the equipment, supplies and staff, and a claim with neither is the global service.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · 
In short: which one you bill depends on the code's PC/TC indicator, what your group did and where the patient was. Medicare allows 26 and TC only on codes with indicator 1, and a hospital pays its own technical component.
How do you decide between 26, TC and no modifier on a claim?
Look up the code, work out what your group actually did, then check where the patient was. Those three answers decide whether the line carries 26, TC or nothing.
- Look up the PC/TC indicator for the code in the Medicare fee schedule file (RVU26D). An indicator of 1 means the test splits into a professional and a technical component, and only then can 26 or TC be used. Indicator 2 codes are professional component only, 3 are technical component only, and 4 are global test only; 26 and TC cannot be used with any of those.
- Decide what your group did. Owned the equipment and read the study: you may be able to bill the global code with no modifier. Read it only: 26. Provided the equipment and staff only: TC.
- Check the patient's status. For radiology services furnished to a hospital inpatient or outpatient, Medicare pays the technical component to the hospital, so a physician claim carries 26 only.
- Set the place of service in item 24B and the service location in item 32. The table in the next section shows the rule for each billing party.
The PC/TC indicator is the step people skip, and it is the one that prevents an invalid modifier. In the October 2026 file, a chest x-ray (71046), a complete heart ultrasound (93306) and a pathology tissue exam (88305) all carry indicator 1. An ECG tracing (93005) is 3, an ECG report (93010) is 2, and the complete ECG (93000) is 4.
The definitions live on the code pages for modifier 26 and modifier TC, and the radiology billing page covers the specialty. Here the question is which one you are.
Which modifier does each billing party use?
| You are | You bill | Place of service and notes |
|---|---|---|
| A practice that owns the machine, employs the reader, and does both in one payment locality | The global code, no 26 and no TC | Global billing is only possible when the same physician or supplier entity furnishes both components in the same fee schedule payment locality. Using the same POS on two claims does not make global billing allowed |
| A practice that owns the machine, but the reading physician sits in another payment locality | TC for the test and 26 for the read, separately | The interpreting physician reports their own address and ZIP code on the 26 claim |
| A physician group that only reads the study for a hospital | 26 only | POS is the setting where the patient received the technical component, such as 22 for on-campus outpatient hospital, or 19 for off-campus outpatient hospital |
| A freestanding imaging center whose studies are read by another group | TC | Paid under the fee schedule when the patient is not a hospital patient and was seen in a freestanding center or physician office |
| A hospital outpatient department | Facility claim, bill types 12X and 13X | Paid under OPPS to the hospital, so the TC is not billed by a physician or supplier |
Teleradiology follows the same rule. Chapter 13, section 150, says the face-to-face requirement does not apply to a read from a distant site, and the POS the physician reports is still the setting where the patient received the technical component. If it is unclear which POS applies, the Medicare contractor can provide guidance.
The fee schedule file shows how the two pieces fit. For a two-view chest x-ray (71046) the non-facility total relative value units are 0.99 for the global code. The 26 row is 0.30 and the TC row is 0.69, and they add up to the global. At the file's conversion factor of 33.4009 that is about $10 for the read and $23 for the technical part, before locality adjustment.
One chest x-ray is billed three ways. Use a made-up global allowed amount of $100, split $35 for the read and $65 for the technical component.
The facility fee versus professional fee post and the facility versus professional billing guide explain why the hospital row has no TC on a physician claim. The OPPS and APC rule covers the payment side.
What goes wrong with 26 and TC, and how do you fix it?
| Problem | What the manual says | Fix |
|---|---|---|
| 26 or TC on a code that does not split | Indicators 0, 2, 3, 4 and 5 do not allow 26 or TC | Remove the modifier. CARC 4 means the procedure code is inconsistent with the modifier used |
| TC billed for a hospital patient | Medicare may not pay the TC of radiology services furnished to hospital patients; the system checks inpatient dates and recoups | Void the TC and let the hospital bill it |
| 26 billed for a quick look at the film | A note like "fx-tibia" or "EKG-normal" is a review already paid through the ED E/M, not an interpretation | Bill 26 only when the record has a written report of findings, clinical issues and comparisons when available |
| Two physicians bill the same ED read | Generally one interpretation of an EKG or x-ray is paid for an ER patient, and the first claim received is generally paid | Agree who bills before submission; a second read needs unusual circumstances and documentation |
| Wrong place of service on the 26 line | The POS for the read is where the patient received the technical component | Correct POS; CARC 5 means the procedure code is inconsistent with the place of service |
One more point for patients with Original Medicare. If a service may be denied as not medically necessary and an ABN is needed, the Medicare fact sheet says any notifier involved can issue it when one provider furnishes the technical component and another the professional component. The GA and GZ post shows how the claim then reads.
How Nucleus Align handles it
Our medical coding team checks the indicator, the setting and the reader on every imaging and diagnostic line, and claims go out within 24 hours of charge entry. Book a call to review how your reads and technical components are split, or see more on the blog.
- Medicare Claims Processing Manual, chapter 13 (Radiology services and other diagnostic procedures) · CMS
- Medicare Claims Processing Manual, chapter 26 (Completing and processing the CMS-1500) · CMS
- Physician Fee Schedule relative value files (RVU26D) · CMS
- Medicare Advance Written Notices of Non-coverage (MLN006266) · CMS MLN
- Claim adjustment reason codes · X12
We check every rule, code and deadline against the official source. See our editorial policy.
Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What do modifiers 26 and TC mean?
Modifier 26 marks the professional component of a diagnostic test: the physician's interpretation and written report. Modifier TC marks the technical component: the equipment, supplies and staff. A code billed with neither is the global service, which covers both. Medicare allows 26 and TC only on codes whose PC/TC indicator is 1.
02Can you use modifier 26 on an E/M visit?
No. In the Medicare fee schedule file, E/M visit codes carry PC/TC indicator 0, a physician service, and the file says modifiers 26 and TC cannot be used with those codes. Modifier 26 belongs on diagnostic tests whose indicator is 1, plus lab interpretations with indicator 6.
03Which place of service goes on a modifier 26 claim?
The setting where the patient received the technical component, per Claims Processing Manual chapter 13, section 150. If the patient had an MRI on an outpatient hospital campus and the physician read it from an office, the physician claim uses POS 22, entered in item 24B of the CMS-1500.
04Does Medicare pay the technical component for a hospital patient?
Not to a physician or supplier. Chapter 13, section 20.2.1, says the A/B MAC may not pay the TC of radiology services furnished to hospital patients. Inpatient TC is in the hospital's payment, and hospital outpatient imaging is paid under OPPS on bill types 12X and 13X.
Talk to a billing lead.
A 20-minute call about your payers, volume and setup. Monday to Friday, 9am to 5pm Eastern.