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), the professional and technical must be billed separately

Incorrect Use

Not appropriate with evaluation and management (E/M) or 

Anesthesia codes

On or after July 1, 2012, 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 the global service (In this case, no modifier would be necessary)

Claim Coding Example

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

CPT 88120 /Modifier 26