Component Modifier Forcing Group

The Component Modifier Forcing Group tool lets you group multiple tools to calculate reimbursement. This tool does not, by itself, calculate any line item reimbursements. It requires “child” tools to be grouped under it that actually perform the reimbursement calculations.

When performing reimbursement calculations, the Component Modifier Forcing Group tool forces the selected modifier onto every line item repriced by the reimbursement tools grouped under it, according to the rules outlined in “Checkpoints” below.

The modifiers you can force with this tool are Professional (26) and Technical (TC). These modifiers distinguish who performed what portion of a procedure. For example, for a claim related to a broken arm, the technician who takes the x-ray of the arm and the physician who diagnoses the broken arm and reads the x-ray may use the same procedure code for the services rendered. However, the technician applies a Technical (TC) modifier to the procedure code, and the physician applies a Professional (26) modifier.

• Reimbursement tools grouped under the Component Modifier Forcing Group tool function as they otherwise would, with the exception of forcing the selected modifier onto the line items they reprice.
• Line items repriced by reimbursement tools not grouped under Component Modifier Forcing Group tool do not receive the forced modifier.
• If you select a modifier in the Force Modifier field:
  • The selected modifier is added to line items that do not have a modifier.
  • For any line item that has a modifier that is not TC or 26, the original modifier is ignored, and the selected modifier is added to the line item.
  • For any line item that has a TC or 26 modifier and the modifier you selected is TC or 26, the original modifier is not changed and the reimbursement is calculated normally.
  • If the procedure code is not found in the lookup table with the forced modifier, the tool then attempts to reprice it without the forced modifier (as it originally appeared on the claim). For more information about matching procedure codes to an entry in a lookup table, refer to Reimbursement Tools.