Modifier 26 is used when only the professional component is being billed when certain services combine both the professional and technical portions in one procedure code.
The PC (Professional Component) is the supervision and interpretation portion of the procedure, and includes indirect practice and malpractice expenses related to that work.
The total RVUs (
Relative Value Units) for codes reported with a 26 modifier include values for physician work, practice expense, and malpractice expense.
Use modifier 26 when a physician interprets but does not perform the test.
If using this modifier with a CCI (Correct Coding Initiative) Column II code reported with a Column I code, the Column II code with the modifier will deny.
Most radiology codes, including ultrasounds, x-rays, CT scans, magnetic resonance angiography, and MRIs may be billed with modifier 26 or TC, or with no modifier at all, indicating that the provider performed both the professional and technical services.
This modifier must be reported in the first modifier field.
Add modifier 26:
When billing only the professional component portion of a test
To report the physician's interpretation of a test
When there is a "1" in the PC/ TC (Technical Component) field on the MPFSDB (Medicare Physician Fee Schedule Data Base)
To procedures falling into the following types of service;
1 - Medical Care/Injections
2 - Surgery
4 - Radiology
5 - Lab
6 - Radiation Therapy
8 - Assistant Surgeon
Do not add Modifier 26 to:
Technical only procedure codes, example: CPT 93005.
Global test only codes, example: CPT 93000.
Professional component only codes. PC / TC indicator 2 of MPFSDB denotes a Professional component only code that identifies stand-alone codes.
An example of a professional component only code is 93010, Electrocardiogram; interpretation and report. Modifier 26 cannot be used with this code.
Re-read results of an interpretation provided by another physician.