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. Blue Cross’s intent is to only pay each component once for the service in its entirety. This could be a result of a single global payment or of two payments (one technical component, indicated by modifier TC, and one professional component, indicated by modifier 26).

Reminder: In-network providers are contractually required to use other in-network providers. This requirement includes situations where professional and technical components of services will be billed separately. When split billing of these services occurs, both entities must be in-network. The purpose of this requirement is to protect patients from unexpected out-of-pocket costs related to out-of-network providers.

This requirement applies to hospitals as well as professional providers. Contact your Provider Engagement Consultant or Hospital Network Consultant with questions. 

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.