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Modifier 26 - professional services

  1. #1
    Default Modifier 26 - professional services
    Exam Training Packages
    I normally do not have to educate on adding modifiers but I do have to make a decision today. We have Hospitalist who is doing ultra sound guided lines and wants to bill 76937. I am being asked if we are to add modifier 26.

    From what I read in the front of the CPT book you add the 26 if you are doing professional services only, does that mean the reporting? Not sure.

    I believe he is doing the procedure only and again the CPT book states there is an add on code.

    Can anyone help???

  2. #2
    Beaverton, Oregon Chapter
    Default Includes Documentation
    If you refer to the guidelines under 76930-76770:
    Includes: Written Documentation

  3. #3
    No offense but that was not helpful. The reason I am asking the question is because as a Hospitalist group we rarely do this and the billing service cannot advise if a TC or 26 is needed to be added. I have read everything on it and am not able to make an intelligent decision. I will try to find another source, thanks anyway.

  4. Smile
    First of all 76937 is an add on code, you must have a primary code such as 76936 in order to bill the 76937.

    Second, if by hospitalist you mean physician, then you use the 26 modifier for the physician billing.

    If you mean the hospital billing then you would put the tc after the code to designate the equipment the hosp provided in order for the physician to perform this.

    Hope this helps

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