technical component and professional component

what is the differences between Technical component and Professional component and how do they affect the reimbursement from the insurance carrier.

re: technical component and professional component

technical component is related to the costs of the equipment and supplies, like, the cost of the machine itself and the supplies related to doing the procedure, like, xray film.

professional component (-26 modifier) is related to the cost of the professional reading and interpreting the study, the doctor reading the test.

For example, if my physician does a surgery that requires visual study during the procedure, he will not bill for the hospital's cost of the machine and its equipment, he will only bill for his part in the procedure, interpreting the visual study so that he can perform the procedure accurately. The hospital owns the machine and pays for the associated equipment, not us.

On the other hand, when a patient comes in to our office to have a study done, we bill for the whole fee, because we own the equipment and the professional who reads it ! :)

(the professional we own... we keep him well fed and we don't turn the heat down too low in his cage at night LOL :) Teasing !! :) )

re: technical component and professional component

Great answer!

There are some articles in Codapedia on the topic

http://codapedia.com/article_248_Report-for-professional-component-of-a-diagnostic-test.cfm

http://codapedia.com/article_265_Modifier-26.cfm

http://codapedia.com/article_264_Diagnostic-test-interpretation.cfm

re: technical component and professional component

I know the difference between technical and professional components, but not how they affect the reimbursement from the insurance carrier.

re: technical component and professional component

The physician and the facility will each get a % of the global allowable. The Medicare fee schedule breaks the RVUs for TC or -26 modifiers down in codes that are affected. It means a reduced reimbursement for the physician using modifier -26. The facility will get the practice expense %.