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Modifier 26

CPT numeric modifiers (AMA · CPT Appendix A)

Modifier 26. Professional Component — bills only the physician's interpretation/supervision portion of a split (PC/TC) service. Valid only on PC/TC indicator '1' codes; the PC share varies by code per MPFS RVUs.

This is a high-denial-risk modifier and a known OIG audit target — append it only when the documentation supports a distinct or separately identifiable service.

Reference only — CPT descriptors are AMA-copyrighted (paraphrased). Payment percentages and acceptance vary by payer; verify against the current CPT/HCPCS files and payer policy.

Related modifiers

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