Long-Term Care

Tips and tools for billing diagnostic tests under Part B

Billing Alert for Long-Term Care, January 1, 2010

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There are two components to diagnostic x-rays and tests: the interpretation of the test (professional component) and the diagnostic test itself (technical component). When the test is provided under arrangement, the vendor should bill the skilled nursing facility (SNF) only for the technical component of the diagnostic x-ray or test. The technical component is the actual performance of the test or procedure. The professional component is billed to the appropriate carrier by or on behalf of the practitioner who interpreted the test.

In addition, the amount paid to the SNF by the Medicare Part B program is only for the technical component. Thus, as you review the Medicare Physician Fee Schedule to determine the Medicare Part B payment amount for a specific procedure, you will see that it is identified with two modifiers: the 26 modifier for the professional component and the TC modifier for the technical component.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

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