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Reminder: Billing Requirements for Non-Split-Billable Services

September 13, 2016

The Department of Health Care Services (DHCS) would like to remind providers of the billing requirements for non-split-billable procedures. Providers should not use modifiers 26 (professional component) or TC (technical component) when billing for a non-split-billable service. Inappropriate use of a modifier or using a modifier when it is not necessary will result in denial or a delay in claim payment.

Some CPT-4 codes and HCPCS codes are inherently non-split-billable and, per their description, are applicable to only the professional or technical component. For these codes, using modifiers 26 or TC causes the claim to suspend.