Modifier 26

Professional Component (PC) 'interpretation' Only (separate from technical component for diagnostic, lab or pathology procedures).

Instructions

  • Indicates physician's interpretation or professional component reported separately (from technical component) for diagnostic, lab or pathology procedures
  • Check Medicare Physician Fee Schedule (MPFS) Indicator and Descriptor Lists
    • Certain codes are divided from global with TC/26 modifiers
    • Technical and professional component fees equal total global allowance
    • Report in first field as a payment modifier

Correct Use

  • Involves global, professional and technical. E.g. 71010, 71010 26 and 71010 TC
  • Place of Service (POS) 21, 22 and 23 only
    • Services appended with modifier 26
    • Facility pays technical portion with modifier TC
  • If 26 and TC are provided in different service locations (enrolled practice locations), professional and technical must be billed separately

Incorrect Use

  • Do not use with evaluation and management (E/M) or Anesthesia codes
  • An independent laboratory may not bill TC of a physician pathology service furnished to a hospital inpatient or outpatient
  • Cannot use separately if provider performed global service (In this case, no modifier would be necessary)

Claim Coding Example

Treatment Description CPT/Modifier
Cytopathology, in situ hybridization (e.g. FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual 88120 26

 

Resource

 

Last Updated Feb 12, 2020