The modifier -26 in CPT is used to indicate what?

The modifier -26 in the Current Procedural Terminology (CPT) coding system is specifically used to indicate the professional component of a service, particularly for procedures that have both a technical and professional component. This applies to diagnostic tests or imaging services where a physician interprets the results but does not provide the actual equipment or facilities used to perform the test. By using modifier -26, coders clarify that the billing is for the interpretation and reporting of the findings, distinguishing it from the technical component that is billed separately.

For instance, in the context of a radiology procedure, the professional component represents the expertise of the radiologist reading the film and providing a report, while the technical component includes the equipment and staff conducting the imaging. This distinction is crucial for proper billing and reimbursement, as different parts of the procedure may be billed by different providers or entities.

Understanding this modifier helps ensure accurate coding and facilitates appropriate payment for the services provided.