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Modifier 26 Description, Examples, and Usage Guidelines

PublishedJanuary 2, 2025 UpdatedOctober 17, 2025

Written By

Fred Allen

Healthcare RCM Expert

Modifiers help you provide additional details while billing for your service. Coding specificity ensures you receive rightful reimbursements every time. Some modifiers help you alert the payer that a procedure took more time, effort, and resources than a typical procedure. Thus, it is eligible for higher reimbursement. Others enable you to provide additional information about a performed procedure and the nature of the service.

This guide will cover everything you need to know about modifier 26, from applicable scenarios to usage guidelines. So, if you are interested in understanding when you should append it and when you should skip it, we advise you to read this guide till the end!

Table Of Contents

Modifier 26 – Description
Modifier 26 – Examples
Accurate Usage Guidelines for Modifier 26
Summary

Modifier 26 – Description

Some procedures in the CPT coding system are a combination of technical and professional components. These procedures typically belong to diagnostic testing, such as CT scans, ECG, and ultrasounds.

Thus, if a physician performs only the professional component (PC) of such a procedure, a modifier 26 will be appended to alert the payer of the specific nature of the service. For the unversed, the physician’s service of interpretation, supervision, and generating a report is referred to as a professional component.

Modifier 26 – Examples

Below are a few examples where you may apply this professional component or PC modifier.

Unattended Sleep Study

Let’s consider a scenario where a patient undergoes a home sleep study test. The patient uses a portable device to record the sleep pattern himself. Contrarily, the sleep specialist will be responsible for analyzing the recorded data, interpreting results, and generating a report.

Thus, the healthcare practitioner would report CPT code 95806 with modifier 26. It will inform the insurance payer that the provider is only billing for the professional component of the sleep study.

ECG Interpretation

Assume a patient experiencing shortness of breath and chest pain, meeting a cardiologist. Thus, recognizing the urgency, the provider orders an electrocardiogram (ECG) to assess the patient’s health.

A technician performs the technical aspects of ECG while the cardiologist interprets the results and generates a report after reviewing the heart rate, rhythm, and any signs of abnormalities.

Here, the cardiologist will report the CPT code 93000 with modifier 26 to ensure rightful reimbursement from the payer.

Ultrasound Interpretation

A patient was concerned about a lump in the thyroid gland. Thus, the primary care physician referred to visit an endocrinologist, who ordered an ultrasound to assess the nature of the lump.

The sonographer performed the ultrasound and captured the images of the thyroid gland, while the endocrinologist reviewed it and suggested the next course of action based on the findings.

Since the endocrinologist only interpreted the images, the claim will include the 76536 CPT code appended with modifier 26 to highlight the professional component of the procedure.

Accurate Usage Guidelines for Modifier 26

Discussed below are a few rules that you should consider when deciding whether or not to append modifier 26 with a CPT code to accurately bill for your rendered care services.

Rule # 1

You should append modifier 26 with the procedural code when the clinician performs the professional component of a global procedure, i.e., conducts interpretation and generates a report but does not perform the procedure.

Rule # 2

You can only append this modifier with CPT codes listed in the CMS national physician fee schedule and relative value files (NPFSRVF) as modifier 26-appropriate.

Rule # 3

Do not append this modifier to global-test-only procedures.

Rule # 4

Avoid using this modifier for professional component-only procedures.

Rule # 5

Do not add this modifier to technical component-only procedures.

Rule # 7

Modifier 26 should not be appended if a practice or institution owns the equipment, purchases the supplies for performing the technical components of the test, and employs the technologist and physician responsible for technical and professional components of the procedure, respectively.

Summary

We covered most aspects of modifier 26, including some practical scenarios where you may apply it to ensure accurate reimbursements. We also discussed some significant rules you must consider while deciding whether or not to use it with a particular procedural code. However, if you still have a question, check out our FAQ section below to find responses to your concerns. Besides, if you have challenges understanding the complex concept of modifiers in the already intricate coding system, we suggest you outsource medical billing workflow to professionals like MediBillMD.

Frequently Asked Questions

Which modifier goes first, 26 or 59?

When deciding the order of modifiers, bear in mind that pricing modifiers always come before the payment modifier. In this case, 26 is a pricing modifier, and modifier 59 is a payment modifier. Thus, you should use 26 before 59.

Can modifier 26 and TC be billed together?

No, you cannot report both 26 and TC together. Global procedures’ descriptors involve both the technical and professional components by default. Thus, you should add either TC or 26, when you want to bill for only one component.

Can we bill modifier 26 with G0317?

Since it is an evaluation and management (E/M) code for a prolonged nursing facility beyond the total time for the primary service, you cannot use 26 with it.

Can you bill modifier 26 with 80048?

No, you cannot bill the CPT 80048 with 26 because it is a laboratory code in which the lab analyst tests the basic metabolic pane (BMP). Thus, it doesn’t contain both components.

Does CPT code 94621 require a modifier 26?

You can use 26 with the 94621 CPT code to bill for only the interpretation and report generation of a cardiopulmonary exercise test (CPET).

Can a modifier 26 be used with CPT 93016?

You don’t need to append this modifier with CPT code 93016 because it denotes a professional component of a cardiovascular stress test and reports the physician’s supervision.

Can modifier 26 be used on CPT 95806?

Physicians use CPT code 95806 to bill for the sleep study test. Thus, if this test is unattended and the physician only interpreted the test results, you should add the PC modifier to inform the payer.

Can you use modifier 26 with CPT 49440?

Yes, you can append this modifier with the CPT 49440 if you are only interpreting the imaging for gastronomy tube placement.

Can you use modifier 26 with CPT 74425?

When you want to receive reimbursement against the CPT code 74425 only for interpreting the antegrade urography examination images, you should submit the claim with 26.

Do you use modifier 26 when billing CPT 88342?

CPT code 88342 is from the surgical pathology procedure range typically used to analyze a tumor tissue and provide a diagnosis. It contains professional and technical components. Thus, you should append this modifier if you have performed only the interpretation and provided a diagnosis.

Does CPT 33207 need modifier 26 for professional billing?

Yes, CPT 33207 will need this modifier if the representative of a medical device company assesses the pacemaker or implantable defibrillator for proper functioning.

Does CPT code 71260 need a modifier 26?

You must include this modifier with the CPT code 71260 if the physician does not perform the computed tomography (CT) examination of the thorax using contrast material and only interprets the results.

Meet the writer

About the Author

Fred Allen

Healthcare RCM Expert

Fred Allen is a healthcare revenue cycle management expert who helps providers optimize billing performance and navigate complex payer requirements. He brings extensive experience in medical billing, denial management, and reimbursement strategies across multiple specialties. At MediBillMD, he reviews and refines content to ensure it is accurate, practical, and aligned with real-world workflows. His insights help healthcare practices improve collections, reduce errors, and stay compliant with evolving payer guidelines.

Modifier 26 Description, Examples, and Usage Guidelines

Modifier 26 – Description