Bill Modifier TC Lately? Expect a Letter

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In CMS
July 30, 2010
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Practitioners, medical groups and clinics, and independent diagnostic testing facilities (IDTFs)—or any eligible professional who has billed for the technical component (TC) of a CPT® advanced diagnostic code in the past six months, for that matter—can expect to receive the first of five letters from a Medicare contractor by Aug. 13. The letter is a reminder that they must be accredited by Jan. 1, 2012 to continue furnishing advanced diagnostic imaging services to Medicare beneficiaries.

Advanced diagnostic imaging includes magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET).

The Centers for Medicare & Medicaid Services (CMS) states in the letter: “Since we expect it can take up to nine months from the time you initiate the accreditation process to completion, we urge you to begin the accreditation process for advanced diagnostic imaging services as soon as possible.”

CMS approved three national accreditation organizations—the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission—to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures. The accreditation requirement applies only to the suppliers of the images themselves, and not to the physicians interpreting the images.

CMS July 9 Transmittal 727 replaces July 2 Transmittal 726 to change the implementation date and July 2010 reporting requirements so contractors have sufficient time to mail this first round of the notification letter to affected providers. Standard X-ray code 72200 Radiologic examination, sacroiliac joints; less than three views has been removed from the list of CPT® codes because it isn’t considered an advanced diagnostic imaging service.

Other diagnostic imaging types excluded from this accreditation requirement include ultrasound, fluoroscopy, and mammography.

4 Responses to “Bill Modifier TC Lately? Expect a Letter”

  1. Linda Garwacki says:

    Our organization bills for Extremity Arterial studies codes 93923 and 93924 using the TC modifier as the 26 portion is billed by the physician at our local hospital who does the actual reading. Therefore I would assume we would receive a letter. However, these are not considered to advanced diagnostic imaging services. Would we need an “Accrediation” to continue to perform these tests? Actually I think these are more on the ultrasound category correct??

  2. Christina Hunter, CCMA-AC, CPC says:

    I dont think that the accrediation would apply to you if you see the referenced transmittal from CMS it states

    “Supplier Billed Advanced Medical Imaging CPT codes for Section 135 (a) of the MIPPA to Receive Accreditation Requirement Notification Letter
    70336 70540 71250 72125 73200 74150
    70450 70542 71260 72126 73201 74160
    70460 70543 71270 72127 73202 74170
    70470 70544 71275 72128 73206 74175
    70480 70545 71550 72129 73218 74181
    70481 70546 71551 72130 73219 74182
    70482 70547 71552 72131 73220 74183
    70486 70548 71555 72132 73221 74185
    70487 70549 72133 73222
    70488 70551 72141 73223
    70490 70552 72142 73225
    70491 70553 72146 73700
    70492 70554 72147 73701
    70496 70555 72148 73702
    70498 70557 72149 73706
    70558 72156 73718
    70559 72157 73719
    72158 73720
    72159 73721
    72191 73722
    72192 73723
    72193 73725
    72194
    72195
    72196
    72197
    72198
    75557 76360 77011 78000 78811
    75559 76376 77012 78001 78812
    75561 76377 77021 78003 78813
    75563 76380 77058 78006 78814
    76390 77059 78007 78815
    76497 77078 78010 78816
    76498 77079 78011 78891
    78015
    78016
    78018
    78020
    78070
    78075
    78099″
    and since your cpt codes dont fall within the scope of the above cpt codes I dont think you should have to worry about getting a letter.

  3. Wayne says:

    Our facility is accredited by the Joint Commission as an whole institution. Is there still a seperate accreditation needed by the imaging departments or is the JCAHO sufficient?

  4. Kvang says:

    Well,

    What is the appropriate modifier for using cpt code 72131 and 72132 then? ‘TC’ modifier got denied with not a appropriate modifier.

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