CO · guidance
CO HCPF Outpatient Imaging and Radiology Billing Manual — Coding Guidelines
CodingGuidelines
Componentmodifiersarerequiredonprofessionalclaimswhenreimbursementissplitbetweentheprofessionalandtechnicalcomponents,regardlessofbillingprovidertype.
Professionalcomponent-modifier26
Technicalcomponent-modifierTC
Professionalclaimslackingacomponentmodifierareunderstoodtobeinclusiveofbothcomponentsandwillbereimbursedaspaymentinfullfortheentireprocedure.Anyseparateclaimforthesameprocedure,billedonthesamedateofservice,willbeconsideredanoverpaymentandmaybesubjecttorecovery.
EffectiveJune1,2018,outpatienthospitalinstitutionalclaimsdonotrequiretheTCtechnicalcomponentmodifierforprocedurecodesthatallowatechnicalandprofessionalcomponentsplit.Thetechnicalcomponent,nottheglobalservice,willbeassumedforthesecodeswhenbilledontheinstitutionalclaim.
NationalCorrectCodingInitiative(NCCI)billingeditsaffectthisbenefit.ProvidersshouldbefamiliarwiththeinformationontheNationalCorrectCodingInitiativeinMedicaidwebpageontheCentersforMedicare&MedicaidServices(CMS)website,includingtheNCCIPolicyManualfoundthere.
AllclaimsmustincludetheNationalProviderIdentification(NPI)numberoftheenrolledproviderwhorenderedtheservice.
AllclaimsmustincludetheNPInumberoftheenrolledproviderwhoorderedtheservice.
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UnlistedradiologyprocedurecodesareusedwhenthereisnoCPTorHCPCScodethataccuratelyidentifiestheservicesperformed.UnlistedprocedurecodeswillbepricedbyaclinicalreviewerwiththeDepartment'sfiscalagent.
ClaimswithunlistedcodesmustincludeasattachmentstheoperatingreportfromtheprocedureandtheUnlistedProcedureCodeFormlocatedontheProviderFormswebpageundertheClaimFormsandAttachmentsdrop-down.AlllinesontheUnlistedProcedureCodeFormmustbecompleted.TheDepartmentwilldenyclaimslackingtherequiredattachments.Claimsdeniedforincompleteinformationwillhavetoberesubmittedwiththecorrectinformationforreimbursement.
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BilateralradiologyproceduresshouldbereportedusingmodifiersRTandLT.Whenusingbothmodifiersforanappropriateradiologycodeonthesameclaim,eachcodeshouldbebilledonaseparatelineoftheclaim:one(1)withmodifierRTindicatingtherightside,andone(1)withmodifierLTindicatingtheleftside.Ifbilateralradiologyproceduresarereportedusingmodifier50,claimsmaybedenied.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
0c6588ee51ac1542ea479c1bd2259124136e495a41f9d7a19cde47830e3d49bb
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