Simplifying Modifiers 26 and TC in Radiology Medical Coding

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Why Modifier Use in Radiology Matters

Radiology medical coding isn’t just about assigning the right CPT® code. It’s about knowing who did what and who owns what. That’s where modifiers -26 and -TC come in and misunderstanding them can mean costly denials or compliance issues. In this blog, we’ll clarify the purpose of these modifiers, when to use them, and how hospitals, physicians, and imaging centers each handle radiology claims.

Whether you’re preparing for the CPC, CCS-P, or CCS, understanding these modifiers is a must-have skill for every forensic medical coder.

What Does Modifier -26 Mean?

Modifier -26 is used to report the professional component of a radiology service. This applies to the physician’s work — specifically, the interpretation and report of the imaging study. It does not include the use of the machine or the technician who performed the scan.

Use -26 when the provider only read the image but did not perform the scan.

Importantly, modifier -26 is only appropriate when the radiologist is not employed by the hospital. Typically, this applies when a radiologist is independent or employed by an outside radiology group. If the radiologist is employed by the hospital, there is no need to bill separately — their services are already included in the hospital’s claim.

Example:
A radiologist from an outside imaging group interprets a chest X-ray performed at the hospital.
Correct Code: 71045-26

What Does Modifier -TC Mean?

Modifier -TC identifies the technical component of the service. This includes:

Use of the radiology equipment
Supplies
The technician’s time

Modifier -TC is appended when the provider or facility is only responsible for the technical aspect of the procedure.

Example:
An independent diagnostic testing facility performs an X-ray but does not interpret the image.
Correct Code: 71045-TC

What About Hospitals? Do They Use -TC?

Here’s where coders often make mistakes.

Hospitals do NOT use modifiers when billing the CPT® code. Also, if the radiologist is employed by the hospital, there is no separate billing for the professional component it’s already captured in the hospital’s claim.

Even if the hospital only performed the scan, it bills 71045 with no modifier.

Example:
A hospital performs a chest X-ray whether they use their own equipment or not, and whether they employ the radiologist or not, each service rendered is billed on a UB-04 form and a revenue code further specifies the service/supply along with a radiology code (e.g. 0324- 71045.
Hospital bills: 71045 (no modifier — global coverage of tech + professional)

When Is the Global Service Billed?

If the same provider or facility performs both the technical and professional components, meaning they own the equipment and interpret the image then no modifier is needed. This is called the global service.

Example: A radiologist owns a private imaging center and performs both the scan and interpretation.
Correct Code: 71045 (no modifier)

MJ GEM – Radiology Medical Coding / Radiology Modifier Rule

Let’s wrap this up with a simple rule that sticks, the AMCI way:

Physicians use modifier -26
Technical providers use modifier -TC
Hospitals apply no modifier
If both components are done by the same provider — no modifier is used
If the radiologist is hospital-employed, no separate 26 is billed — they are included in the hospital’s claim

This GEM ensures that AMCI Coders code radiology like forensic professionals with accuracy, ethics, and guideline clarity.