Updates to claims edit software system

At Quartz, we strive to keep you informed about changes that may affect your practice. On May 1, 2023, the following update will occur in our claims edit software system.

26/TC split billed without global procedure

Quartz will activate this edit to ensure proper coding and billing of global procedures. The edit will apply when different claim lines are submitted with professional component modifier 26 and technical component modifier TC for the same procedure code on the same date of service by the same physician.

• The Principles of CPT® Coding states: “The professional and technical components together are referred to as “global service.” If the same physician/QHP performs the technical and professional components, it is not appropriate or necessary to report the components of the service separately.”

This edit will be enforced for all Quartz lines of business except BadgerCare Plus. Services previously reimbursed may no longer receive payment if codes are not billed following these guidelines. For additional information, please see the Provider Manual Medical Claims and Coding Policies (starting on page 52).