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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say A/B MACs (B) may not pay for the technical component (TC) of radiology services furnished to 
hospital patients. Payment for physicians radiological services to the hospital, e.g., administrative or 
supervisory services, and for provider services needed to produce the radiology service, is made by the AB 
MAC (A) to the hospital as a provider service. AB MACs (A) include the TC of radiology services for hospital 
inpatients, except Critical Access Hospitals (CAHs), in the prospective payment system (PPS) payment to 
hospitals. Hospital bundling rules exclude payment to suppliers of the TC of a radiology service for 
beneficiaries in a hospital inpatient stay. CWF performs reject edits to incoming claims from suppliers of 
radiology services. Upon receipt of a hospital inpatient claim at the CWF, CWF searches paid claim history and 
compares the period between the hospital inpatient admission and discharge dates to the line-item service date 
on a line-item TC of a radiology service billed by a supplier. The CWF will generate an unsolicited response 
when the line-item service date falls within the admission and discharge dates of the hospital inpatient claim. 
You can find this information in the Medicare Claims Processing Manual Chapter 13 - Radiology Services and 
Other Diagnostic Procedures; Section 20.2.1 - Hospital and Skilled Nursing Facility (SNF) Patients. 
 
The rules say many of the diagnostic services, including radiology services, provided by 
physicians/practitioners contain both a technical component (TC) and a professional component (PC). Often, 
the PC and TC of diagnostic services are furnished in different settings. As a general policy, the POS code 
assigned by the physician/practitioner for the PC of a diagnostic service shall be the setting in which the 
beneficiary received the TC service. E. Determination of Payment Locality Under the Medicare physician fee 
schedule (MPFS), payment amounts are based on the relative resources required to provide services and vary 
among payment localities as resource costs vary geographically as measured by the geographic practice cost 
indices (GPCIs). The payment locality is determined based on the location where a specific service code was 
furnished. For purposes of determining the appropriate payment locality, CMS requires that the address, 
including the ZIP code for each service code be included on the claim form in order to determine the 
appropriate payment locality. The location in which the service code was furnished is entered on the ASC X12 
837 professional claim format or in Item 32 on the paper claim Form CMS 1500. Separate Billing of 
Professional Interpretation If the same physician or other supplier entity does not furnish both the TC and PC of the diagnostic service, or if the same physician or other supplier entity furnishes both the TC and PC but the 
professional interpretation was furnished in a different payment locality from where the TC was furnished, the 
professional interpretation of a diagnostic test must be separately billed with modifier -26 by the interpreting 
physician. You can find this information in the Medicare Claims Processing Manual, Chapter 13  Radiology 
Services and Other Diagnostic Procedures, Section 150  Place of Service (POS) Instructions for the 
Professional Component (PC or Interpretation) and the Technical Component (TC) of Diagnostic Tests. 
 
The rules say 1 = Diagnostic tests or radiology services: This indicator identifies codes that describe diagnostic 
tests, e.g., pulmonary function tests, or therapeutic radiology procedures, e.g., radiation therapy. These codes 
generally have both a professional and technical component. Modifiers 26 and TC can be used with these 
codes. The total RVUs for codes reported with a 26 modifier include values for physician work, practice 
expense, and malpractice expense. The total RVUs for codes reported with a TC modifier include values for 
practice expense and malpractice expense only. The total RVUs for codes reported without a modifier equals 
the sum of RVUs for both the professional and technical component. You can find this information in the 
Medicare Claims Processing Manual, Chapter 23 Fee Schedule Administration and Coding Requirements, 
Section 50.6  Physician Fee Schedule Payment Policy Indicator File Record Layout. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.