Practice Management Alert

Recoup Professional Component Pay With Modifier -26

When your provider orders an x-ray or other exam that requires a physician's professional interpretation of the results, you need to know how to apply modifier -26 (Professional component) to collect the payment you deserve. Follow the guidelines below for appropriate modifier -26 use.

Do Append -26 When:

Your practice has an arrangement with a hospital or other imaging center in which the facility bills only for the technical component and then your physician performs the reading and interpretation of the results. You should append modifier -26 to the service code to indicate your physician deserves payment for the professional component only.

A patient seeks a second opinion from your physician. If a patient asks your physician to read test results that another physician has already interpreted, you can bill the appropriate service code with modifier -26 because your physician is performing the service on a separate and later date than the original interpretation.

Don't Append -26 When:

Your physician performs both the service's technical component and professional component (reading and interpreting the results). Instead, you should bill for the entire service using the global code for the service (for example, 71010, Radiologic examination, chest; single view, frontal).

The physician who performs the service also interprets the results and bills the global code for both technical and professional components. If your physician also interprets the results on the same day and attempts to bill for the service with modifier -26, the carrier will deny for a repeat procedure on the same date of service.