CPT modifier
Modifier 26: Professional component
Modifier 26 is a CPT modifier. In plain terms: Bills only the physician's part of a service that has a professional part and a technical part, such as reading an X-ray or EKG.
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- Modifier
- 26
- Type
- CPT (Level I) modifier, maintained by the AMA
- Plain description
- Bills only the physician's part of a service that has a professional part and a technical part, such as reading an X-ray or EKG.
- How it is used
- Used when the equipment, staff and supplies (the technical component, modifier TC) belong to another entity, such as a hospital.
- Claim form
- CMS-1500 item 24D, up to four modifiers per line. 837P SV101-3 to SV101-6.
The CPT descriptor is AMA copyright and is not shown here. The description above is written by Rivvi. Read the CMS guidance linked above for Medicare's rules.
Professional and technical components
Related modifiers
- TCTechnical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'TC' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
- 27Multiple outpatient hospital E/M visits on the same date
- 25Significant, separate E/M visit on the same day
- 32Mandated services
- 24Unrelated E/M visit in the postoperative period
- 33Preventive services
- 23Unusual anesthesia
- 47Anesthesia by the surgeon
Related pages
Questions
What does modifier 26 mean?
Modifier 26 is a CPT modifier. In plain terms: Bills only the physician's part of a service that has a professional part and a technical part, such as reading an X-ray or EKG.
Is modifier 26 a CPT or a HCPCS modifier?
26 is a CPT (Level I) modifier. The AMA maintains CPT modifiers. Two-character codes with a letter, such as GT or XU, are HCPCS Level II modifiers from CMS.
Where does modifier 26 go on a claim?
On the CMS-1500 it goes in item 24D next to the procedure code. Each line holds up to four modifiers. On an 837P it goes in SV101-3 to SV101-6.
When is modifier 26 used?
Used when the equipment, staff and supplies (the technical component, modifier TC) belong to another entity, such as a hospital.
What denial comes back when a modifier is wrong?
A missing or mismatched modifier often comes back as CARC 4. A modifier that was not valid on the date of service comes back as CARC 182. A bundling edit the modifier should have bypassed comes back as CARC 97 or 236.