California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.3 - Official Medical Fee Schedule › Section 9789.12.9 - Professional Component (PC)/Technical Component (TC) Indicator

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Medicare PC/TC Indicators have been adapted for
						workers' compensation and have the following meanings:
0 =
Physician Service Codes--Identifies
								codes that describe physician services. Examples include visits, consultations,
								and surgical procedures. The concept of PC/TC does not apply since physician
								services cannot be split into professional and technical components. Modifiers
								26 and TC cannot be used with these codes. The RVUS include values for
								physician work, practice expense and malpractice expense. There are some codes
								with no work RVUs.
1 =
Diagnostic Tests for Radiology
								Services--Identifies codes that describe diagnostic tests. Examples are
								pulmonary function tests or therapeutic radiology procedures, e.g., radiation
								therapy. These codes 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 include values for physician
								work, practice expense, and malpractice expense.
2 =
Professional Component Only Codes--This
								indicator identifies stand-alone codes that describe the physician work portion
								of selected diagnostic tests for which there is an associated code that
								describes the technical component of the diagnostic test only and another
								associated code that describes the global test. An example of a professional
								component only code is CPT code 93010--Electrocardiogram; Interpretation and
								Report. Modifiers 26 and TC cannot be used with these codes. The total RVUs for
								professional component only codes include values for physician work, practice
								expense, and malpractice expense.
3 =
Technical Component Only Codes--This
								indicator identifies stand-alone codes that describe the technical component
								(i.e., staff and equipment costs) of selected diagnostic tests for which there
								is an associated code that describes the professional component of the
								diagnostic test only. An example of a technical component only code is CPT code
								93005-Electrocardiogram; Tracing Only, without interpretation and report. It
								also identifies codes that are covered only as diagnostic tests and therefore
								do not have a related professional code. Modifiers 26 and TC cannot be used
								with these codes. The total RVUs for technical component only codes include
								values for practice expense and malpractice expense only.
4 =
Global Test Only Codes--This indicator
								identifies stand-alone codes that describe selected diagnostic tests for which
								there are associated codes that describe (a) the professional component of the
								test only, and (b) the technical component of the test only. Modifiers 26 and
								TC cannot be used with these codes. The total RVUs for global procedure only
								codes include values for physician work, practice expense, and malpractice
								expense. The total RVUs for global procedure only codes equals the sum of the
								total RVUs for the professional and technical components only codes
								combined.
5 =
Incident To Codes--This indicator
								identifies codes that describe services covered incident to a physician's
								service when they are provided by auxiliary personnel employed by the physician
								and working under his or her direct personal supervision. These services are
								not payable when they are provided to hospital inpatients or patients in a
								hospital outpatient department. Modifiers 26 and TC cannot be used with these
								codes.
6 =
Laboratory Physician Interpretation
								Codes--This indicator identifies clinical laboratory codes for which separate
								payment for interpretations by laboratory physicians may be made. Actual
								performance of the tests is paid for under the lab fee schedule. Modifier TC
								cannot be used with these codes. The total RVUs for laboratory physician
								interpretation codes include values for physician work, practice expense, and
								malpractice expense.
7 =
Physical therapy service, for which
								payment may not be made--Payment may not be made if the service is provided to
								either a patient in a hospital outpatient department or to an inpatient of the
								hospital by an independently practicing physical or occupational
								therapist.
8 =
Physician interpretation codes--This
								indicator identifies the professional component of clinical laboratory codes
								for which separate payment may be made only if the physician interprets an
								abnormal smear for hospital inpatient. This applies to CPT codes 88141 and
								85060. No TC billing is recognized because payment for the underlying clinical
								laboratory test is made to the hospital, generally through the Hospital Fee
								Schedule payment rate.
No payment is recognized for CPT codes
								88141 and 85060 furnished to hospital outpatients or non-hospital patients. The
								physician interpretation is paid through the clinical laboratory fee schedule
								payment for the clinical laboratory test.
9 =
Not Applicable--Concept of a
								professional/technical component does not apply.
1. New
						section filed 9-24-2013; operative 1-1-2014. Submitted to OAL as a file and
						print only pursuant to Government Code section
						11340.9(g)
						(Register 2013, No. 39).
Note: Authority: Sections
						  133,
						  4603.5,
						  5307.1 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  5307.1 and
						  5307.11, Labor
						  Code.