When should modifier 26 be used?


Editorial team Published on

Modifier 26 is used when a provider bills only for the Professional Component (PC) of a global medical service, such as a physician interpreting a diagnostic test or X-ray without owning the equipment or performing the technical part.

When to Use Modifier 26

  • Physician Interpretation: The healthcare provider reviews, interprets, and writes a distinct, signed report for a test.
  • Split Services: The procedure is performed using a facility's or another entity's equipment, supplies, and staff (billed separately with modifier TC).
  • Valid Codes: The assigned CPT code has a separate professional and technical designation on the Medicare Physician Fee Schedule (MPFS) (usually indicated by a PC/TC indicator of 1 or 6).

When NOT to Use Modifier 26

  • Global Service: When the same provider performs both the technical and professional components and owns the equipment.
  • Built-in Professional Codes: When the CPT code already describes the professional-only interpretation service (e.g., CPT 93010).
  • Technical-Only Billing: When billing for equipment use, supplies, or technician labor alone.