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Wiki radiology and -26 modifier with E/M

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leannm21

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Leechburg, PA
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I am currently working denials and have found a lot of denials coming through with not paying for any radiology with a -26 modifer when submitted with an E/M (with appropriate -25 appended). I cannot locate any documentation on guidelines from any NY State Medicaid carrier. If anyone has any knowledge in this your advice would be greatly appreciated!
 
Are you submitting an office visit along with the radiology procedure/test? I wonder if your issue isn't that you are submitting both the E/M and the radiology code with POS 11? If you are performing and reading the test in the office, then you'd bill it without the 26 modifier as you own the equipment. You would use the 26 modifier if you were performing the service at a facility.
 
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