Claims submitted for the global or technical component of certain ultrasound procedures when billed in combination with other ultrasound procedures for a single member within the same visit will be denied as they are considered to be included within another procedure.
In these instances, Tufts Health Plan will compensate the imaging service with the highest allowable compensation amount at 100% of the Tufts Health Plan compensation rate and subsequent procedure(s) that are considered to be included in the other ultrasound procedure will be denied.
Professional/Technical Components
**Tufts Health Plan does not add or remove modifiers 26 (professional component) or TC (technical component) to procedure codes requiring the presence or absence of those modifiers in order to apply existing professional and technical component edits. Tufts Health Plan will not compensate for procedure codes requiring modifiers 26 and/or TC if they are not billed in accordance with the current payment policy.
**Tufts Health Plan will not compensate for diagnostic tests and radiology services having a professional component performed in a home, assisted living facility, nursing facility or skilled nursing facility if those services are billed without modifier 26 to indicate the professional component and transportation of portable x-ray equipment (R0070-R0075) is not also submitted.
**Tufts Health Plan will not compensate for a procedure code requiring modifier TC if a facility bills without modifier TC.
