Modifier 26 Description(2023) | Medical Billing RCM

The modifier 26 is basically a unique coding tool in the billing and coding world.

In the procedure coding, it can be appended to indicate that the service offered was reading and interpreting the results of a diagnostic or laboratory service.

It is used when the professional component is billed when certain services put together both the professional and technical portions in a single procedure code.

When should Modifier 26 be used?

There are a number of times when mod 26 would be needed to use. To be precise, here are some of those situations:

Situation 1

When a sleep centre performs polysomnography for a patient and has no physician associated with the facility.

This leads to the interpretation of finding the test, while this is the time when a physician would append mod 26 to 95811 in order to represent the interpretation of the polysomnography.

Situation 2

Another situation is when a treating physician orders a test from an external laboratory for the patient.

After which the laboratory pathologist would provide a written interpretation to the physician he is serving.

Here, the pathologist would want to represent the interpretation by billing the process 83020 long with the mod 26 code.

What is the inappropriate use of Modi 26?

Wondering what is the inappropriate use of 26 modifier code? So let’s walk through them.

Re-reading the results of an interpretation provided by a different physician.

Technical only procedure codes for example CPT 93005

Global tests only codes for example CPT 93000

Professional “component only” codes PC / TC indicator 2 of MPFSDB denotes a professional “component only” code that identifies a stand-alone code

FAQ- Frequently Asked Question

Q1. Can modifier 26 and TC be billed together?

Ans. Modifier 26 and TC both consist of professional and technical components and can be used with these codes.

Q2. What does modifier 26 represent?

Ans. The modi 26 code represents the professional component of a global service or procedure.
It also includes the provider work, associated overhead, and professional liability insurance costs.

Q3. Can the anesthesiologist use the modifier 26 code?

Ans. Modifier 26 should only be used when any physician or non-physician provider tends to render the professional component of a global procedure or service code. It has never been reported on evaluation and management services codes.