Global Charges in Medical Billing: Knowing the Difference Between Global, Professional and Technical Charges

Global charges in medical billing are procedure charges billed whole, with no modifier, because one entity supplied both the physician’s work and the equipment, room and staff. When those come from two entities, the charge splits into a professional component (modifier 26) and a technical component (TC).

Practices and facilities set up their arrangements with physicians in many different ways, and the billing has to follow the arrangement. Once you know who owns the equipment and who employs the physician, you know which modifier to use.

Where you see it

Place	What goes there
Medicare Physician Fee Schedule	Three rows for a splittable code: global (no modifier), 26 and TC, each with its own RVUs; the PC/TC indicator says whether the code splits
CMS-1500 box 24D, 837P loop 2400	Modifier 26 or TC in the first modifier position, or nothing for global
Hospital’s UB-04 or 837I	The technical side of a hospital patient’s service, as a facility charge with no 26 or TC
Remittance advice	The allowed amount shows which component was priced; a global allowed on a hospital-based claim means the payer will recoup an overpayment
Patient’s EOB	Two entries for one date, one from the physician group and one from the hospital, which patients read as a duplicate

The three components

Professional. The physician’s time and expertise only: interpreting the images, supervising the simulation, reviewing and approving the plan, managing the course. Billed with modifier 26 on codes that allow it. For example, an IMRT plan reviewed and approved by a physician contracted to a hospital is 77301-26. The charge covers the physician’s work only, not the facility, the planning system or the dosimetrist.

Technical. Everything but the physician: the linear accelerator, the planning software, the therapists, dosimetrists and physicists, the room and the supplies. In a hospital it is the hospital’s charge on its own claim. In a freestanding center that lets a separately billing physician use its equipment, it is 77301-TC on the center’s claim.

Global. No division of cost because one entity did it all. 77301 with no modifier. Medicare’s manual says the technical component is paid under the physician fee schedule only to beneficiaries who are not hospital patients, in “a physician’s office, a freestanding imaging or radiation oncology center, or other setting that is not part of a hospital.” For hospital patients the technical side is paid to the hospital.

Which arrangement are you in?

Arrangement	Who owns the equipment and employs the staff	Who employs the physician	Physician group bills	Facility bills
Freestanding center	the practice	the practice	global, no modifier	nothing separate
Hospital department, contracted physicians	the hospital	the physician group	26 on splittable codes; professional-only codes as is	technical side on the institutional claim
Hospital department, employed physicians	the hospital	the hospital	the hospital’s billing office bills 26 under the physician’s NPI	technical side on the institutional claim
Mixed: a group with its own center that also covers a hospital	depends on the site that day	the group	global at the center, 26 at the hospital	the hospital, for its own site

Most errors happen in the mixed arrangement. The same physician bills the same code with two different modifiers depending on where the patient was treated, and the biller has to get it right line by line. If a global charge goes out with 26, the practice is paid the professional rate for work that included the technical side, and in radiation oncology the technical portion is by far the larger share. If a professional charge goes out without 26, the practice is overpaid at the global rate, the hospital’s technical claim conflicts with it, and the overpayment has to be refunded. CMS lists exactly this as an approved Recovery Audit Contractor topic: codes with PC/TC indicator 1 billed with 26 or TC but paid at the wrong rate.

Codes that do not split

Not every radiation oncology code has three versions. The fee schedule’s PC/TC indicator decides:

Indicator	Example codes (2026)	How they bill
1, splittable	77280, 77290, 77295, 77300, 77301, 77307, 77334, 77338, 77387	global, 26 or TC
2, professional only	77427, 77431, 77432, 77435	as is, no modifier, in every setting
3, technical only	77336, 77370, 77402, 77407, 77412	as is, no modifier, only where the technical side is payable
0, physician service	99213 and the other E/M codes	never split

So a hospital-based physician bills 77427 without 26, and a freestanding center bills 77412 without TC. The modifier only goes on indicator 1 codes. The full indicator table and the denials for getting it wrong are in Modifier 26 and TC.

Worked example: one IMRT plan, two sites

A patient’s IMRT planning is billed as 77301 (the plan) and 77338 (the multileaf collimator device). The 2026 national fee schedule values are 58.69 and 14.22 RVUs global, 12.55 and 6.74 for the 26 components, and 46.14 and 7.48 for the TC components, at a conversion factor of 33.4009. National amounts before geographic adjustment and sequestration; illustrative.

Site	Physician group bills	Group’s allowed	Facility bills
Freestanding center owned by the group	77301, 77338 (global)	72.91 RVUs = 2,435.26	nothing separate
Hospital outpatient department, group contracted	77301-26, 77338-26	19.29 RVUs = 644.30	hospital’s institutional claim under OPPS
Freestanding center, visiting physician who bills separately	the physician: 77301-26, 77338-26 (644.30)		the center: 77301-TC, 77338-TC, 53.62 RVUs = 1,790.96

Professional plus technical equals global: 644.30 plus 1,790.96 is 2,435.26. This holds for every split code. A claim that bills global where a component was due, or a component where global was due, is either an overpayment or an underpayment.

What to do

• Write the arrangement down per site. For each facility a physician works at, record who owns the equipment, who employs the physician, and therefore which component the group bills. Set the default modifier in the billing system from that record so nobody decides it at charge entry.
• Look up the indicator every time. Before adding 26 or TC to any code, confirm the PC/TC indicator is 1. Indicator 2 and 3 codes bill as is wherever the service happens.
• Reconcile with the hospital. When you bill 26, someone at the hospital bills the technical side for the same dates. A quick monthly check that both sides exist catches missed charges on either end.
• Prepare the patient explanation. “The hospital bills for the machine and the staff; our bill is for the doctor” answers most calls.
• Denials and recoveries to recognize: CARC 4 with RARC N519 (modifier not allowed on this code); CARC 16 with N822 (payer expected a modifier); a global payment on a hospital-based claim that later recoups. Modifier errors are corrections and resubmissions, not appeals.
• Iridium Suite’s claim scrubber flags a global-capable code billed in place of service 22 without modifier 26, and the practice configures each facility’s default so the modifier follows the site of service.

Related terms

• Modifier 26 and TC
• Facility vs non-facility rates
• Place of service codes
• POS 22, outpatient hospital
• CPT 77427, radiation treatment management
• Rendering provider vs billing provider

Further reading: CMS Medicare Claims Processing Manual, Chapter 13, sections 20.1 and 20.2 (payment conditions for the professional and technical components); Noridian: Billing Professional and Technical Components; CMS Recovery Audit topic 0116, Modifiers TC and PC: Incorrect Coding; CMS PFS Relative Value Files.