What is a 26 modifier?
Asked by: Melvin Pollich IV | Last update: August 5, 2025Score: 4.6/5 (74 votes)
When should modifier 26 be used?
What you need to know. Modifier 26 is defined as the professional component (PC). The PC is outlined as a physician's service, which may include technician supervision, interpretation of results and a written report. Use modifier 26 when a physician interprets but does not perform the test.
What is an example of a modifier 26?
Examples of when to use modifier 26:
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.
What is an example of a technical component?
defining technical components such as software, data stores, servers, and devices with regards to a particular problem setting.
Can modifier 26 and 59 be used together?
Yes I have seen 59 and 26 modifiers together. I work for a cardiology practice and when we do Left Heart Catherizations and Stents on the same day, we use the following modifiers in the following order: 26,59,51. That is telling the payer that there are multiple procedures done on the same patient at the same time.
MODIFIER 26 PROFESSIONAL COMPONENT MEDICAL CODING EXPLAINED
What is a 59 modifier used for?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
Which modifier goes first 26 or 50?
Always add 26 before any other modifier. If you have two payment modifiers, a common one is 51 and 59, enter 59 in the first position.
What is the difference between technical and professional billing?
The technical component is frequently billed by suppliers like independent diagnostic testing facilities and radiation treatment centers, while the professional component is billed by a physician or other health care practitioner.
What is modifier 58?
Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.
When to use modifier 90?
Independent laboratories shall use modifier 90 to identify all referred laboratory services. A claim for a referred laboratory service that does not contain the modifier 90 is returned as unprocessable if the claim can otherwise be identified as being for a referred service.
What is a technical component modifier?
What Is Modifier TC? The technical component includes the provision of all equipment, supplies, personnel, and costs related to the performance of the procedure. The payment for the technical component portion also includes the practice expense and the malpractice expense.
What are examples to use modifier 52?
Example One
A provider performs a unilateral tonsillectomy for a ten-year-old patient (CPT code 42820). In this case, apply modifier 52. This CPT assumes bilateral surgery, so to show that it was only performed on one side, or electively reduced, modifier 52 would be appropriate.
What is the modifier 26 on CPT 93306?
Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the echocardiogram results, not the technical component.
Can modifier 26 only be used by technical providers?
Modifier 26 is used by a physician who performs the professional component of a service, and Modifier TC is used when only the technical component of a service is performed. There are times when it is important to specify these separate services.
How do I know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).
What is the difference between technical component and professional component pathology?
The technical component (TC) of physician pathology services refers to the preparation of the slide, involving tissue or cells that a pathologist will interpret. (In contrast, the pathologist's interpretation of the slide is the professional component (PC) service.
What is the 50 modifier?
Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).
What is modifier 60?
The CPT manual introduced modifier -60 in 2001 to allow providers to indicate when a procedure was more complex than normal due to an altered surgical field.
What is modifier 80?
Current Procedural Terminology (CPT®) Modifier 80 - CPT Modifier 80 represents assistant at surgery by another physician. This assistant at surgery is providing full assistance to the primary surgeon.
What is the 59 modifier used for?
Definitions. Modifier 59 describes a distinct procedural service, and is used to identify procedures and services that are not normally reported together.
What is 57 modifier?
CPT modifier 57 may be used to report the decision for surgery for certain codes. This modifier may be used to indicate that an evaluation and management (E/M) service performed on the same day or the day before a major surgery (090 global days) by the surgeon resulted in the decision to perform the procedure.
What is CPT code 99203 used for?
CPT code 99203 is used for new patient office visits that require a medically appropriate history and/or examination and a low level of medical decision making. The typical time for a CPT code 99203 visit is 30-44 minutes. Proper documentation of the care components is essential to support billing for this code.
What is a 58 modifier used for?
To start, modifier 58 is a surgical-specific modifier, used to indicate a staged or related procedure or service by the same physician during the postoperative period.
What is the modifier 52 rule?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
What is the HCPCS code?
The Healthcare Common Procedure Coding System (HCPCS) is a national, uniform coding structure developed by the Centers for Medicare & Medicaid Services (CMS) to standardize the coding systems used to process Medicare and Medicaid (Medi-Cal) claims on a national basis.