Acquaint Yourself with the MPFSDB Indicators
The MPFSDB provides more than just a list of carrier-specific maximum fees per procedural code. The MPFSDB is the national database used by MACs to ensure that claims processing is consistent nationally. Medicare uses this fee schedule when paying for the following services:
Professional services of physicians and other enrolled healthcare professionals in private practice
Services covered incident to physicians’ services (other than certain drugs covered as incident-to services)
Diagnostic tests (other than clinical laboratory tests)
Radiology services
The payment-policy indicators in the MPFSDB provide information, such as global surgery days, multiple surgery indicators and applicability of professional and technical components.
Understanding the Professional and Technical Component Indicator
The MPFDBS professional component (PC) and technical component (TC) modifier indicator identifies codes that can or cannot be reported as an individual component by appending modifier 26 (PC) or (TC) modifier.
The following indicators identify codes as global, professional, or strictly technical, as defined by CPT. Other indicators categorize codes that are strictly physician services or incident-to or ancillary services that are not payable when provided in the inpatient or outpatient setting.
| PC/TC indicator | Rationale |
|---|---|
| 0 | Physician service, modifiers 26 and TC do not apply |
| 1 | Diagnostic services, modifiers 26 and TC apply |
| 2 | Professional component by definition: modifiers 26 and TC do not apply |
| 3 | Technical component by definition: modifiers 26 and TC do not apply |
| 4 | Global procedure or service, modifiers 26 and TC do not apply |
| 5 | Incident-to code (not a physician service): modifiers 26 and TC do not apply |
| 6 | Laboratory physician interpretation code: modifier TC does not apply |
| 7 | Physical therapy service |
| 8 | Physician interpretation codes: applies only to code 85060. Modifier TC does not apply |
| 9 | Concept of professional/technical does not apply |
<small>Source: Medicare Physician Fee Schedule Data Base – Relative Value Files</small>
Determining CPT Code PC/TC Indicators
The following examples demonstrate the applicability of the PC/TC indicator for a specific service or procedure.
Evaluation and management (E/M) Service Codes: E/M codes describe physician services that cannot be split into professional and technical components. The PC/TC indicator “0” indicates codes in which the concept of PC/TC does not apply. Examples include visits, consultations, and surgical procedure.
Incident-to Codes: Indicator “5” identifies codes that describe services covered incident-to a physician’s service when they are provided by auxiliary personnel employed by the physician and working under his or her direct supervision. Payment may not be made by carriers for these services when they are provided to hospital inpatients or patients in a hospital outpatient department. Modifiers 26 and TC cannot be used with these codes.
Searching the MPFSDB
Access the MPFSDB at https://www.cms.gov/apps/physician-fee-schedule/overview.aspx. Begin a search from the MPFS Overview page, either by clicking on the “Physician Fee Schedule Search” in the navigation bar at the top of the page or scroll down and select “Start Search.” To continue, click “Accept”’ to indicate you have read and agree to the License for Use of Current Procedural Terminology, Fourth Edition (“CPT®”).
The screen for the MPFS Search Criteria will appear once you have accepted the CPT® license agreement (see the following MPFS search-criteria screen) . The following steps will assist you in navigating the database:
1. Choose the year from the dropdown menu
2. Select the Type of Information for the search. For PC/TC indicators, select Payment Policy Indicators.
3. Select a single HCPCS (CPT) code or range of codes
4. Enter the HCPCS code(s) for the search
5. Select one of the modifier options for the dropdown menu. For the PC/TC indicator, select the option, Global (Diagnostic Service) or Physicians Professional Service in which the PC/TC concept does not apply
