Modifier 26

Modifier 26 is a CPT® modifier used to indicate that the physician practice performed the professional component only of a diagnostic test.  There is no CPT® modifier for the technical component.  The facility that performs only the technical component uses a HCPCS modifier, TC.

Some diagnostic tests have both a professional and a technical component.  These are indicated in the Medicare Physician Fee Schedule. 

A physician practice bills for these diagnostic services globally when the physician provides the entire service: the equipment, supplies, staff to perform the service and the professional interpretation.  However, if the physician performs only the interpretation, this service is billed with modifier 26. This is typically the case when the service is provided at another facility, rather than the physician office.

Billing for the professional component requires that the physician interpret the results of the test. The results are the image/tracing/report provided by the machine.  The physician must document a separate report, which includes the patient identifying information, date, indications, brief description of the test (spirometry, or number of views) and findings.  The physician must sign the report.  Findings noted in the progress note are not sufficient to bill for the professional component.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)