tci Medicare Compliance & Reimbursement - 2016 Issue 9

Reader Question: Tell the Payer What You Are Coding For

Question: When should I use modifier 26? Answer: CPT® designed modifier 26 (Professionalcomponent) for use when reporting professional services in which the code is a combination of professional and technical components. When your provider only performs the professional component of the service, modifier 26 tells the payer that you are only coding for that portion of the service and thus payment will be made for the professional services. You should also use modifier 26 when the provider performs a procedure with both a technical and professional component in an off-site facility, in other words, in a place of service...

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