Technical Vs. Professional Component Explained (2022)

Procedures include a technical and professional component; in some claims, only one component must be billed. Below we explain the difference between technical en professional components in medical billing.

1. What Is A Professional Component?

A professional component describes a provider’s work, which depends on their skills or knowledge.  

1.1 Example

An example of a professional component is CPT code 93010: “Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only.

Physicians rely on their skills to interpret and report the ECG procedure results. They need to understand that the graphs will differ from a normal healthy heart if diseases such as mitral stenosis, atrial fibrillation, or acute myocardial infarction are present.

Therefore, the physician needs to know how to interpret and report the ECG graphs, which is an excellent example of a professional component.

1.2 How To Bill The Professional Component Only

Some CPT codes, like CPT 93010, include a professional component alone. You can not add a modifier to the claim in those cases because the CPT code does not have a technical component.

If a procedure has both components, report modifier 26 if you want to bill the professional component only.

If the same provider performs the technical and professional components of the service, it is not appropriate to report the professional and technical components of the service separately.

2. What Is A Technical Component?

Technical components of a procedure do not rely on knowledge or skills from the performing provider. For example, the medical tools or the staff are technical components during a procedure.

2.1 Example

An example of a procedure with a technical component alone is CPT 93005: “Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report.”

The description of this code says ‘without interpretation and report.’ Therefore, it is without a professional component and only consists of a technical component.

2.2 Billing Guidelines

Do not use modifier TC with a procedural code with only a technical component. You can only use the TC modifier if the CPT code consists of both components, but the technical component needs to be billed alone.

3. Global Test Only Codes

Global tests are CPT codes that describe;

• the technical component of the test only; and
• the professional component of the test only.

These tests can not be billed with modifier 26 or TC because they only have a professional or technical component.

4. Physician Service Codes

Examples of physician service codes are consultations or visits. These services can not be split into professional and technical components; therefore, they can not be billed with modifier TC or modifier 26.

5. Diagnostic Tests Or Radiology Services

Diagnostic tests (for example, pulmonary function tests) or therapeutic radiology procedures (for example, radiation therapy) have a professional and technical component and can be billed with one component only.

You can use modifier 26 for the professional component of diagnostic tests or radiology services and modifier TC for the technical component only.

5. Laboratory Physician Interpretation Codes

The interpretation of clinical laboratory is paid separately. The tests are paid under the lab fee schedule.

These codes can not be billed with modifier TC.

6. References

https://www.cms.gov/files/document/r10320cp.pdf