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Many CPT codes have both professional and technical components. Some examples include diagnostic x-rays, pathology services and other testing procedures such as EKGS, stress tests, nerve conduction tests and other similar testing procedures.   

Some insurers allow these services to be billed separately using the 26 and TC modifiers. However, Blue Cross and Blue Shield of Alabama requires global billing for these services in an in-office setting by the credentials of the provider who rendered the professional portion of the service. (This requirement does not apply to Blue Advantage^®.)

• Example #1: Pathology services should not be billed under the lab itself, but instead under the credentials of the pathologist who performed the professional component.  
• Example #2: A physician uses an out-of-state entity to perform the technical component of a cardiac testing service while he performs the professional component. The claim should be billed globally by the physician, and he is responsible for reimbursing the other entity for their technical services.
• Example #3: A physician sends a patient to a free-standing radiology center for the technical component of an x-ray, but that ordering physician performs the reading himself. The claim should be billed globally by the ordering/reading physician who is responsible for reimbursing the radiology center for its technical component.

An exception is made for services when the technical component is provided in the hospital setting because the technical component will be included on the facility claim. In this instance, the provider performing the professional service would use the appropriate CPT code with modifier 26 as applicable.  

Blue Cross does not recognize the Independent Diagnostic Testing Facility (IDTF) classification allowed by some other payors. We require claims to be billed and processed under the credentials of the professionals performing the service.