What Is Modifier 26?
Modifier 26 is appended to a diagnostic procedure code to indicate that only the professional component — physician interpretation and report — is being billed, with the technical component (equipment, supplies, tech) billed separately by another entity.
- Confirm whether the practice owns/employs the equipment and technologist (bill global), the equipment only (bill TC), or only the interpretation (bill 26).
- Cardiology and radiology groups should map their TC/26 split for every diagnostic CPT they perform.
Modifier 26
Also known as: Professional Component Modifier
Modifier 26 is appended to a diagnostic procedure code to indicate that only the professional component — physician interpretation and report — is being billed, with the technical component (equipment, supplies, tech) billed separately by another entity.
Definition
Modifier 26 isolates the physician interpretation portion of a diagnostic service. It is used when a physician reads/interprets a study (X-ray, MRI, ECG, echo, EEG, pathology slide) performed at a facility owned by another entity. Combined with the facility's TC bill, the two parts replicate the global service. CMS publishes the TC/26 indicator on each CPT in the MPFS — some codes have TC/26 splits, some are global-only.
Example
A radiologist reading an MRI performed at a hospital outpatient imaging center bills CPT 70551-26. The hospital bills CPT 70551-TC. Total payment to the two entities equals the global MRI fee, distributed per the MPFS TC/26 split.
Common Misconceptions
Some practices bill global (no modifier) when they should bill 26 — typical when a physician group reads studies at a hospital but mistakenly bills as if they own the equipment. Audit findings often catch this and demand refunds for the TC portion paid in error.
Practical Application
Confirm whether the practice owns/employs the equipment and technologist (bill global), the equipment only (bill TC), or only the interpretation (bill 26). Cardiology and radiology groups should map their TC/26 split for every diagnostic CPT they perform.
Related Terms
Modifier TC
Modifier TC is a HCPCS Level II modifier appended to diagnostic procedures (imaging, cardiology testing, EEG, etc.) to indicate that only the technical component — equipment, supplies, technologist labor, and overhead — is being billed, not the professional interpretation.
Read definition arrow_forwardCPT (Current Procedural Terminology)
CPT is the five-digit procedural code set developed and maintained by the American Medical Association that describes medical, surgical, and diagnostic services performed by physicians and qualified health professionals; it is HIPAA-named for use in claims.
Read definition arrow_forwardRVU (Relative Value Unit)
An RVU is a unit of measure in the Medicare Resource-Based Relative Value Scale (RBRVS) representing the relative resources required to perform a CPT/HCPCS service, comprising work, practice expense, and malpractice components.
Read definition arrow_forwardWhere This Applies on MedPrecision
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