Beginning July 1, 2018 for our commercial members, Harvard Pilgrim will no longer reimburse a physician or other health care professional for a procedure code that CMS has assigned a PC/TC indicator of 3 when it is billed with a facility place of service code, because those procedure codes are payable only to the facility.
A PC/TC indicator of 3 identifies stand-alone codes that describe the technical component — such as staff and equipment costs — of selected procedure codes. Codes with a PC/TC indicator of 3 should not be billed by the physician because this indicator represents work done by the facility staff rather than physician work. Additionally, because a PC/TC indicator of 3 also identifies codes that are covered only as diagnostic tests and therefore do not have a related professional code, modifiers 26 (professional component) and TC (the technical component of procedures that are a combination of a physician component and a technical component) should not be used with these codes, and doing so will result in a denial.
For more information, refer to Harvard Pilgrim’s Coding Overview Payment Policy.