{"id":20676,"date":"2019-01-09T09:00:49","date_gmt":"2019-01-09T14:00:49","guid":{"rendered":"http:\/\/www.carecloud.com\/continuum\/?p=20676"},"modified":"2025-10-21T17:30:33","modified_gmt":"2025-10-21T17:30:33","slug":"modifier-26","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/modifier-26\/","title":{"rendered":"Procedure Coding: When to Use the Modifier 26"},"content":{"rendered":"<h2><span style=\"font-weight: 400;\">Procedure Coding: When to Use the Modifier 26<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><\/h2>\n<h3>This is part of the Modifier Series, the articles include:<\/h3>\n<ul>\n<li>Modifers<a href=\"https:\/\/www.carecloud.com\/continuum\/modifier-59-25-91-guide-coders\/\"> 59, 25, and 91<\/a><\/li>\n<li>Modifier <a href=\"https:\/\/www.carecloud.com\/continuum\/procedure-coding-when-to-use-the-59-modifier\/\">59<\/a><\/li>\n<li>Modifier <a href=\"https:\/\/www.carecloud.com\/continuum\/procedure-coding-25-modifier\/\">25<\/a><\/li>\n<li>Modifier <a href=\"https:\/\/www.carecloud.com\/continuum\/modifier-26\/\">26<\/a><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The 26 modifier is a particularly unique coding tool in the billing and coding world. As we know, a modifier explains to payers the specific work that was done by a physician during the treatment of a patient. This concept is taken a step further when modifier 26 is needed. This is because modifier 26 can <\/span><i><span style=\"font-weight: 400;\">only<\/span><\/i><span style=\"font-weight: 400;\"> be used for certain kinds of procedures which include a \u201cprofessional component\u201d. For this reason, knowing when to appropriately use the 26 modifier frequently causes confusion among billers. <\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">In order to help dispel some of the confusion, this article will explore some of the most common uses of modifier 26, and discuss the requirements of when and how to utilize it correctly. <\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">DEFINING MODIFIER 26 <\/span><\/h2>\n<p><span style=\"font-weight: 400;\">In procedure coding, you\u2019ll find that there are certain procedures that are a combination of a <\/span><b>professional component<\/b><span style=\"font-weight: 400;\"> and a <\/span><b>technical component.<\/b><span style=\"font-weight: 400;\"> Most often, you\u2019ll see this among diagnostic testing procedures such as ultrasounds or CT scans. When the <\/span><b>professional component<\/b><span style=\"font-weight: 400;\"> of one such procedure is performed separately, the specific service performed by the physician may be identified by adding the modifier 26. Let\u2019s break that down a little further.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">\u201cProfessional component\u201d is <\/span><a href=\"https:\/\/www.novitas-solutions.com\/webcenter\/portal\/MedicareJL\/pagebyid?contentId=00094624&amp;_afrLoop=615379844402813#!%40%40%3F_afrLoop%3D615379844402813%26centerWidth%3D100%2525%26contentId%3D00094624%26leftWidth%3D0%2525%26rightWidth%3D0%2525%26showFooter%3Dfalse%26showHeader%3Dfalse%26_adf.ctrl-state%3Dyvxg1hil6_33\"><span style=\"font-weight: 400;\">outlined<\/span><\/a><span style=\"font-weight: 400;\"> as a physician\u2019s service which may include supervision, interpretation, or a written report, <\/span><i><span style=\"font-weight: 400;\">without<\/span><\/i><span style=\"font-weight: 400;\"> having performed the test. <\/span><span style=\"font-weight: 400;\">In short, modifier 26 in its correct use reports that a physician\u2019s service was to interpret the results of a test when they didn\u2019t personally perform it. Wondering when would this type of scenario occur? The following examples of modifier 26 in use will help us understand how to correctly define and report a physician\u2019s professional component.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">CLINICAL SCENARIOS<\/span><\/h2>\n<h3><strong>Examples of when to use modifier 26:<\/strong><\/h3>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">A sleep center performs polysomnography for a patient. A physician not associated with the sleep center facility interprets the findings of the test. This physician would\u00a0<\/span><a href=\"https:\/\/www.texmed.org\/Template.aspx?id=34447\"><span style=\"font-weight: 400;\">append modifier 26<\/span><\/a><span style=\"font-weight: 400;\"> to 95811 to represent her interpretation of the polysomnography. <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">A pregnant patient presents to the ER with premature contractions. The ultrasound performed in the hospital detects abnormalities in the pregnancy. The patient is referred to a specialist for follow-up, and the hospital imaging report is sent with the patient for further review. The specialist reviews and interprets the ER ultrasound, so the specialist would use modifier 26 on the ultrasound CPT to represent their interpretation-only service of the report. <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">A treating physician orders a test from an outside laboratory for his patient. The lab\u2019s pathologist then provides their written interpretation to the attending physician. In this case, the pathologist could bill the procedure 83020 with a modifier 26 representing <\/span><a href=\"https:\/\/med.noridianmedicare.com\/web\/jeb\/topics\/modifiers\/26\"><span style=\"font-weight: 400;\">their interpretation<\/span><\/a><span style=\"font-weight: 400;\"> of the test. <\/span><\/li>\n<\/ul>\n<h3><strong>Incorrect use of the 26 modifier:<\/strong><\/h3>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">To illustrate incorrect use, the treating physician in the example<\/span> <span style=\"font-weight: 400;\">above<\/span><i><span style=\"font-weight: 400;\"> cannot <\/span><\/i><span style=\"font-weight: 400;\">bill 83020- 26 themselves after they review the pathology report, because the pathologist has already interpreted the test. The treating physician can include her own interpretation in her medical decision-making, but should not bill separately for it. <\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">SUMMARY<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Understanding the correct and appropriate use of modifier 26 will be key to filing clean claims and avoiding denials for duplicate billing. Remember, the facility that performed the test must also file a claim for reimbursement of the technical component. This is why reporting modifier 26 on the same procedure code for the interpreting doctor will be critical in demonstrating your provider\u2019s specific role in the service performed. As such, reporting the 26 modifier correctly decreases your likelihood of incorrect payer denials and reduces delayed payment.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It can be easy to become confused trying to keep the components of a procedure straight and remembering when modifier 26 should be applied. A helpful tip to keep in mind is this: if the provider doesn\u2019t own the <\/span><a href=\"https:\/\/www.radiologytoday.net\/archive\/rt0812p14.shtml\"><span style=\"font-weight: 400;\">technical equipment<\/span><\/a><span style=\"font-weight: 400;\">, they can\u2019t bill for the technical component. In order to bill correctly, the use of modifier 26 conveys that the provider only performed the professional component of the procedure.<\/span><\/p>\n<p><span style=\"display: none;\" data-sumome-listbuilder-embed-id=\"63167955acecc7c017d1349e21976b34c69d1681cdcbe88c9a25211c5006fd11\">DUMMYTEXT<\/span><\/p>\n<p><strong>Sources:<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/www.texmed.org\/Template.aspx?id=34447\">https:\/\/www.texmed.org\/Template.aspx?id=34447<\/a><\/li>\n<li><a href=\"https:\/\/med.noridianmedicare.com\/web\/jeb\/topics\/modifiers\/26\">https:\/\/med.noridianmedicare.com\/web\/jeb\/topics\/modifiers\/26<\/a><\/li>\n<li><a href=\"https:\/\/www.radiologytoday.net\/archive\/rt0812p14.shtml\">https:\/\/www.radiologytoday.net\/archive\/rt0812p14.shtml<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Procedure Coding: When to Use the Modifier 26 This is part of the Modifier Series, the articles include: Modifers 59, 25, and 91 Modifier 59 Modifier 25 Modifier 26 The 26 modifier is a particularly unique coding tool in the billing and coding world. As we know, a modifier explains to payers the specific work [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[389],"tags":[],"class_list":["post-20676","post","type-post","status-publish","format-standard","hentry","category-resources"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Procedure Coding: When to Use the Modifier 26 - Continuum<\/title>\n<meta name=\"description\" content=\"Understanding the correct and appropriate use of modifier 26 will be key to filing clean claims and avoiding denials for duplicate billing.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/carecloud.com\/continuum\/modifier-26\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Procedure Coding: When to Use the Modifier 26 | Carecloud - ContinuumU\" \/>\n<meta property=\"og:description\" content=\"The 26 modifier is a particularly unique coding tool in the billing and coding. 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