Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111
www.mass.gov/dma	
	MassHealth
	Acute Inpatient Hospital Bulletin 127
	January 2004

	TO:	Acute Inpatient Hospitals Participating in MassHealth

	FROM:	Beth Waldman, Acting Commissioner

	RE:	Billing for Physician Services with a Professional and a Technical Component

Reminder	This bulletin is a reminder to acute inpatient hospitals about billing for radiology, surgical pathology, medical diagnostic, and some surgical services provided by hospital-based physicians and hospital-based entities. These specific services comprise both a technical and professional component.  Hospitals may bill only the professional component of the services, because the technical component is included in the standard payment amount per discharge, outlier, transfer-per-diem, or psychiatric per diem payment.

Billing 	When billing for physician services that have both a technical and a professional component (either electronically or on the no. 5 paper claim form), hospitals must append modifier 26 to the appropriate service code. Claims with service codes that require use of modifier 26 that are billed without it will be denied with error code 135 (“modifier required”).  On the HIPAA-compliant 835 remittance advice transaction, this denial will be reflected as an adjustment reason code 04, and remarks code M78.

For a listing of services with both a technical and a professional component, refer to the Division of Health Care Finance and Policy regulations at 114.3 CMR 16.00, 17.00, and 18.00, which can be found at http://www.state.gov/dhcfp.

Questions	If you have any questions about this bulletin, please contact MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.