Wiki Modifiers - 26 and -90

[jzastrow]

Can you append a - 26 and a -90 modifier to a single CPT code? This would be for the professional component only of send out laboratory tests. (Example: 88121-2690) Thank you for your help!

 

[danskangel313]

I'm not quite understanding the situation. Can you clarify what's actually happening in this circumstance? A specific (example) CPT code would also be helpful.

 

[Ajesh Kuriakose]

Can you append a - 26 and a -90 modifier to a single CPT code? This would be for the professional component only of send out laboratory tests. (Example: 88121-2690) Thank you for your help!

this may help you. It has an example for modifier 90, which will be helpful.
https://www.aapc.com/blog/24559-dont-look-past-modifiers-90-99/

 

[thomas7331]

The 26 / 90 combination would not be appropriate. 26 is for the professional component which has to be billed by the physician performing the interpretation. 90 is specific to laboratory services. You can't refer a professional service to a laboratory.

 

[danskangel313]

Using code 88121 for an example, by definition and description, this includes BOTH the technical component AND the interpretation by the lab analyst or scientist. "Physicians may NOT submit claims for a CPT code 88120 and 88121 professional component when the interpretive information is provided by a lab technician or scientist. Per Chapter 10 in the NCCI Policy Manual for Medicare Services, Version 16.3, the physician work component requires a physician to read, quantitate and interpret the tissues/cells stained with the probes(s)."

If you are referring to a situation in which a provider obtains the specimen and sends it to an outside lab for processing, that provider could not bill for the pathology services. However, depending on the specific circumstances, the provider could potentially bill for the service(s) he/she performed to obtain the sample.