Reimbursement Restrictions

Reimbursement for split-billable radiology services is limited to one technical component (modifier TC) and one professional component (modifier 26) for each procedure, or an equivalent total amount of the two combined (modifier ZS).  Billings in excess of the two components combined will be denied. 

When using a unilateral radiographic procedure code to bill for bilateral radiographic procedures, providers must bill with the appropriate Procedure-4 code and modifier (TC, 26 or ZS), enter a quantity of two units and indicate, in the Remarks field (Box 80)/Reserved

for Local Use field (Box 19) or on an attachment, that the procedure was performed bilaterally.  Providers must not use modifiers RT or LT, or bill on multiple claim lines.

Diagnostic Physicians

Diagnostic physicians (radiologists) may claim reimbursement for their professional part (modifier 26) of such services.  If they also supply the equipment, supplies, housing and technician services, they may bill appropriately for the complete procedure (modifier ZS) involving both professional and technical components