MRA and MRI – Inactive modifirs

Effective for dates of service on or after August 1, 2010, modifier ZS will no longer be reimbursable with MRI, MRA and PET scans. Providers will be required to use modifiers 26 (professional component) and TC (technical component) with CPT-4 codes used to bill MRI, MRA and PET scan services. Providers are instructed to use one of the following scenarios when submitting a Treatment Authorization Request (TAR) for services requiring authorization.

Scenario 1: One TAR and one provider for both the professional (26) and technical (TC) components of service. 

The TAR must be submitted with two lines of service. The first line must have the CPT-4 code and one of the two modifiers (26 or TC). The second line must have the same CPT-4 code and the corresponding modifier (26 and TC).

Scenario 2: One TAR and two different providers for the professional (26) and technical (TC) components of service. This is the preferred method for two different providers. 

One of the two providers submits the TAR on behalf of both providers of the two components of service(26 and TC) and both providers should use the same TAR for claim submission. The TAR must be submitted with two lines of service. The first line must have the CPT-4 code and one of the two modifiers (26 or TC). The second line must have the same CPT-4 code and corresponding modifier (26 or TC).

Scenario 3: Two TARs and two different providers for the professional (26) and technical (TC) components of service. 

Each provider submits their own TAR with one line of service and the appropriate modifier (26 or TC) designating the service they will provide or have provided.