tci Part B Insider - 2012 Issue 7

Reader Question: Technical Clinical Lab Services Fall Under Separate Fee Schedule

Question: Our laboratory billed the global charge for 84165, but then the pathologist, who is not employed by us, billed 84165-26. I'm concerned that the insurance company won't pay us both. What's the correct way to bill this service if our lab performs the test but a separate pathologist interprets it -- should we use modifier TC?Answer: No, you should not use modifier TC (Technical component). The insurer should pay for the test the way it was billed: Your lab bills 84165 (Protein; electrophoretic fractionation and quantitation, serum)The pathologist bills 84165-26 (... professional component). Here's why: Medicare splits...

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