Radiology and Laboratory Modifier Update

Laboratory Codes will be identified as either split-billable or not split-billable. Effective for dates of service on or after July 1, 2008, laboratory and radiology codes will be identified as either split-billable services or services that are not split-billable:

• Split-billable services: These services are separately reimbursable by different providers for a professional and technical component. The facility and physician each bill for their respective component of the service with modifier 26, TC or ZS.
• Services that are not split-billable: These services are not separately reimbursable by different providers for a professional nor technical component. Only one provider may be reimbursed for these codes. These codes must not be submitted with modifier 26, TC or ZS.

Laboratory and radiology services that were previously defined as Ò100 percent professional or 100 percent technicalÓ will no longer be identified as split-billable, and must not be billed with modifier 26, TC or ZS. Manual pages reflecting this policy will be released in the June Medi-CalUpdate and Family PACT Update along with a reprint of this article.