The PC/TC indicator tells you whether a code splits into a professional component (the physician's interpretation, billed with modifier 26) and a technical component (the equipment, supplies, and staff, billed with modifier TC)—and, if not, why.
Who bills it, and where Copy link
Enter a code and where the patient is. The answer reads the code’s PC/TC indicator in the current release and shows who bills each part.
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96372 · PC/TC indicator 5: Incident-to service · Hospital outpatient clinic · Facility rate · Q4 2026 release
The hospital bills 96372. CMS does not pay the physician for incident-to codes when the patient is a hospital outpatient.
| Who bills | What | National PFS baseline |
|---|---|---|
| Hospital | 96372 | Paid to the hospital outside the PFS |
See 96372’s amounts in each locality
National amounts (GPCI 1.000) before sequestration.
The split, and its exceptions Copy link
Indicator 1 marks the split itself: diagnostic tests and radiology services that CMS prices three ways—global, -26, and -TC. Indicators 2, 3, and 4 mark tests CMS codes as separate stand-alone codes instead: 2 is a professional-only code, 3 a technical-only code, and 4 a global code whose two parts have their own codes. For example, 93000 (indicator 4) combines 93005 (indicator 3) and 93010 (indicator 2). Modifiers 26 and TC cannot be added to codes with indicators 2, 3, or 4. Indicator 0 covers physician services such as visits and surgery, which have no components to split. The remaining values cover narrower cases: incident-to services (5), lab physician interpretation codes (6), therapy services with a hospital payment restriction (7), and a single blood-smear interpretation code (8). Indicator 9 means the concept does not apply.
PC/TC indicator values Copy link
All ten values, in one table:
| Value | Meaning |
|---|---|
| 0 | Physician service—no PC/TC split |
| 1 | Diagnostic test or radiology service that splits into professional (-26) and technical (-TC) components |
| 2 | Professional-component-only code |
| 3 | Technical-component-only code |
| 4 | Global-only code whose professional and technical parts have separate codes |
| 5 | Incident-to service; not payable for hospital inpatients or outpatients |
| 6 | Lab physician interpretation code; the test itself is paid under the Clinical Laboratory Fee Schedule |
| 7 | Therapy service not payable when an independent therapist furnishes it to a hospital inpatient or outpatient |
| 8 | Physician interpretation of an abnormal smear for a hospital inpatient (85060 only); no technical component billing |
| 9 | Concept does not apply |
Indicator 5 in a hospital outpatient clinic Copy link
Indicator 5 codes, such as 96372, 96365, and 95115, are incident-to services: care the physician’s own staff provide under the physician’s supervision, billed on the physician’s claim. CMS does not pay the physician for them when the patient is a hospital inpatient or outpatient. A hospital outpatient clinic counts as outpatient when it is a provider-based department of the hospital. There, the hospital bills the service on its own claim, and it is paid outside the Physician Fee Schedule—under the OPPS at most hospitals (see facility fee vs physician fee). The physician still bills their own work, such as the visit, at the facility rate. A code page may list a facility amount for an indicator 5 code, but that amount does not override the rule: what matters is where the patient is. In a physician’s office, or a clinic the physician runs outside the hospital, the practice bills these codes under the Physician Fee Schedule as usual.
Frequently asked Copy link
When can I bill both -26 and -TC?
Only when the code's PC/TC indicator is 1 and CMS has published priced -26 and -TC lines for it in that release. Every code page shows the modifier amounts its indicators support.
Why is there no -26/-TC split shown for some codes?
Most codes are physician services (indicator 0), outside the concept entirely (9), or stand-alone component codes (2, 3, and 4), so there is no second modifier line to price.
Can a physician bill a PC/TC indicator 5 code in a hospital outpatient clinic?
No. Indicator 5 codes are incident-to services, and CMS does not pay the physician for them when the patient is a hospital inpatient or outpatient. In a provider-based hospital clinic, the hospital bills the service on its own claim.
Sources Copy link
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01 CMS Medicare Physician Fee Schedule Relative Value Files—supports 3 statements
CMS Medicare Physician Fee Schedule Relative Value Files
- PC/TC indicators 2, 3, and 4 mark stand-alone professional-component-only, technical-component-only, and global-test-only codes, and modifiers 26 and TC cannot be used with them.
- PC/TC indicator 7 marks therapy services that may not be paid when an independently practicing physical or occupational therapist furnishes them to a hospital inpatient or outpatient; indicator 8 applies only to 85060, a physician interpretation paid separately only for a hospital inpatient.
- PC/TC indicator 5 marks codes for services covered incident to a physician’s service, and A/B MACs may not pay for these services when they are provided to hospital inpatients or patients in a hospital outpatient department.
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03 CMS Medicare Benefit Policy Manual (Pub. 100-02)—supports 1 statement
CMS Medicare Benefit Policy Manual (Pub. 100-02)
- Hospital outpatient therapeutic services incident to a physician’s service, including clinic services, must be furnished by the hospital or under arrangements made by the hospital, in the hospital or in a department with provider-based status under 42 CFR 413.65; these policies differ from incident-to services in office and physician-directed clinic settings.
Written from primary CMS sources—see how we source, compute, and verify everything on this site.
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