Modifier 26 and Modifier TC in Medical Billing: Professional, Technical and Global Components

Modifier 26 marks the professional component of a procedure: the physician’s interpretation, supervision or management, billed apart from the equipment and the staff who ran it. Modifier TC bills that technical component. A code with neither modifier is global, both components together.

The rules are simple. Most errors come from losing track of which arrangement applies to the physician at each site, for each code.

Where you see it

Place	What goes there
CMS-1500 box 24D	The modifier, in the first modifier position after the CPT code (payment modifiers go first)
837P electronic claim	Loop 2400, SV101 composite: the procedure code followed by up to four modifiers
Medicare Physician Fee Schedule RVU file	Three rows for a splittable code: the bare code (global), the 26 row and the TC row, each with its own RVUs, plus a PC/TC indicator column that says whether the code splits at all
Remittance advice	The modifier prints beside the code on the service line; the allowed amount shows which component the payer priced
Hospital’s institutional claim	The hospital’s technical charges for the same service, on the UB-04 or 837I, never with 26 or TC

Three ways to bill one code

	Global (no modifier)	Professional (26)	Technical (TC)
Pays for	physician work plus equipment, room, staff and supplies	physician work only, with a share of practice expense and malpractice	equipment, room, staff and supplies, with no physician work
Billed by	one entity that owns the equipment and employs or contracts the physician	the physician or physician group	the owner of the equipment: a hospital on its own claim, or a freestanding center on a professional claim
Typical site	freestanding center, physician office	hospital outpatient department (POS 22), inpatient (POS 21)	the freestanding center billing for a physician who bills separately

Medicare’s rule for radiology services, which includes radiation oncology, is that the professional component is paid under the fee schedule in all settings, while the technical component is paid under the fee schedule only when the patient is not a hospital patient. For hospital inpatients and outpatients the technical component is paid to the hospital through the inpatient or outpatient prospective payment system, not to the physician. (Medicare Claims Processing Manual, Chapter 13, sections 20.1 and 20.2.)

Which codes split: the PC/TC indicator

Every code in the Medicare Physician Fee Schedule carries a one-digit PC/TC indicator. It is the only authority on whether 26 or TC is allowed.

Indicator	Meaning	Modifiers 26 and TC
0	Physician service (visits, consults, surgery)	not allowed
1	Diagnostic test or therapeutic radiology procedure with both components	allowed
2	Professional component only; a stand-alone physician code	not allowed
3	Technical component only; a stand-alone equipment and staff code	not allowed
4	Global test only, with separate PC and TC codes	not allowed
5	Incident-to code (auxiliary staff, office setting)	not allowed
9	Concept does not apply	not allowed

Radiation oncology examples, checked against the October 2026 RVU file:

Code	Service	Indicator	How it bills
77300	Basic dosimetry calculation	1	global, 26 or TC
77301	IMRT planning	1	global, 26 or TC
77338	IMRT multileaf collimator device	1	global, 26 or TC
77387	Image guidance for radiation treatment delivery	1	77387-26 for the physician only; the TC row is bundled (status B) into the delivery codes in the 2026 fee schedule
77370	Special medical radiation physics consultation	3	technical only, no modifier; payable only where the TC is payable
77336	Continuing medical physics consultation	3	technical only, no modifier
77402, 77407, 77412	Radiation treatment delivery	3	technical only, no modifier
77427	Radiation treatment management, five fractions	2	professional only, no modifier
77431, 77432, 77435	Management: short course, SRS, SBRT	2	professional only, no modifier
99213	Office visit	0	never split

One change worth knowing: effective January 1, 2026, CPT deleted 77014 (CT guidance, the usual split-code example in the older articles on this site), the IMRT delivery codes 77385 and 77386, and 77401, and HCPCS retired G6001 through G6017. Treatment delivery is now 77402, 77407 and 77412 by complexity level, all technical-only, with image guidance bundled into them; the physician’s image guidance work is 77387-26. Superficial therapy moved to 77436 through 77439. If you see 77014 or 77385 on a 2026 claim, it will reject.

Worked example: 77301 at two sites

Dr. Patel plans an IMRT course. The national 2026 fee schedule values for 77301 are 58.69 RVUs global, 12.55 RVUs for the 26 component and 46.14 RVUs for the TC, at a conversion factor of 33.4009. The dollar figures below are national amounts before geographic adjustment and before sequestration, so treat them as illustrative.

Scenario	Billed as	Allowed	Medicare 80 percent	Patient 20 percent
Freestanding center, physician employed by the center	77301, no modifier	1,960.30	1,568.24	392.06
Hospital outpatient department, physician contracted	77301-26 by the physician group	419.18	335.34	83.84
Same hospital case, the hospital’s side	the hospital’s institutional claim, paid under OPPS	priced by OPPS, not the fee schedule

The two mistakes have opposite effects. If the group bills 77301 with no modifier at the hospital, it claims 1,960.30 for work worth 419.18; a payer that pays it has overpaid by 1,541.12, and that money has to go back. If the freestanding center bills 77301-26 by habit, it leaves 1,541.12 of technical work unbilled, and no denial comes back to show the error.

What to do

• Load the PC/TC indicator into your charge master. It is a column in the free RVU file CMS publishes each quarter. A code with indicator 0, 2 or 3 should never carry 26 or TC, and your system should refuse it.
• Set the modifier by site, not by hand. Decide once per facility: this site bills global, this site bills 26. The site on the physician’s schedule then sets the modifier.
• Match the hospital. When you bill 26, the hospital bills the technical side. If one of you bills global, the payer sees a duplicate and one claim denies or recoups.
• Explain it to patients. Two statements for one treatment, from the physician group and from the hospital, look like double billing. A one-line explanation at check-in saves a phone call later.
• Denials to recognize: CARC 4 (procedure code inconsistent with the modifier) with RARC N519 (invalid combination of HCPCS modifiers) when 26 or TC is added to a code whose indicator does not allow it; CARC 16 with N822 (missing procedure modifier) when a payer expects 26 at POS 22. Both are corrections, not appeals. A paid line with an allowed amount far below the fee schedule usually means the payer priced a component you did not intend.
• Iridium Suite’s claim scrubber flags a global-capable code billed in place of service 22 without modifier 26 at charge entry, with the reason beside the line.

Related terms

• Global, professional and technical charges
• Facility vs non-facility rates
• Place of service codes
• POS 22, outpatient hospital
• CPT 77427, radiation treatment management
• CMS-1500 box by box

Further reading: CMS Medicare Claims Processing Manual, Chapter 13, Radiology Services (sections 20 and 70); CMS PFS Relative Value Files (the PC/TC indicator is a column in each release); Noridian: Billing Professional and Technical Components; Noridian: Modifier 26.