Modifier 26 can be confusing, so we’d love to break it down for you. Basically, it’s only used when the professional component is being billed and certain services combine both the professional and technical portions in one procedure code. But what does that mean and when do you use it?
Well, the PC (Professional Component) is the supervision and interpretation portion of the procedure and includes indirect practice and malpractice expenses related to that work. The total RVUs (Relative Value Units) for codes reported with a 26 modifier include values for physician work, practice expense, and malpractice expense. You use modifier 26 when a physician interprets but does not perform the test.
Download The Only Modifier 26 Cheatsheet You’ll Ever Need, for free and hang it somewhere in your office for moments when you need a little clarification and don’t have time for tedious research. The cheatsheet covers modifier 26 with a correct coding initiative and acceptable use.