Modifiers · CPT modifier

Professional component

Modifier 26 flags that a physician provided only the interpretive, cognitive portion of a diagnostic service—reading the images, analyzing the findings, and producing a signed written report—while a separate entity owned and operated the equipment and employed the technician who performed the actual test. It applies when the professional and technical work are split between two billing parties.

Verified May 8, 2026 · 7 sources ↓

Type: CPT
CPT codes use it: 89
Top regions: Spine, General, Foot & ankle

Drawn from AMACMSNovitas SolutionsAAPCHorizon Blue

When to use modifier 26

Source · Editorial brief grounded in 7 cited references ↓

Append modifier 26 when a physician interprets a diagnostic study but did not own or operate the equipment used to perform it. The classic split-billing scenario in orthopedics: a hospital or outpatient imaging center runs the CT or MRI scanner and bills the technical component (modifier TC), while the reading physician—often a radiologist, but sometimes the treating orthopedic surgeon—submits the same CPT code with modifier 26 to capture only the interpretation and written report. Both parties use the same base CPT code; the modifiers tell the payer which slice of the work each bill covers.

Modifier 26 is appropriate only when the physician's interpretation is separate, documented, and signed—not a quick verbal note. The written report must stand on its own: it should describe findings, compare to prior studies where relevant, and carry the interpreting physician's signature. CMS requires this report to exist before the claim is submitted. Place modifier 26 in the first modifier field of the claim line.

Do not use modifier 26 when the physician performed the entire service—equipment, supervision, and interpretation—in a setting the practice owns, such as a fluoroscopic stress view taken in an orthopedic office. In that situation, bill the global code with no modifier. Also avoid modifier 26 on CPT codes that are already defined as professional-component-only (PC/TC indicator 2 on the Medicare Physician Fee Schedule Database), such as 93010 for ECG interpretation; those codes already capture only the professional work, and adding modifier 26 will cause a denial.

Orthopedic scenarios

Concrete situations in orthopedic practice that warrant modifier 26.

Source · Editorial brief grounded in AAOS coding guidance and cited references ↓

A patient presents to the ED after a fall; the hospital performs a CT of the knee (CPT 73701) using its own scanner. An orthopedic surgeon later reviews the axial slices remotely, documents a written report noting a tibial plateau fracture pattern, and signs it. The surgeon bills 73701-26; the hospital bills 73701-TC. POS on the surgeon's claim reflects the hospital, not the office.
An outpatient surgery center performs arthroscopic knee surgery (CPT 29881). Intraoperative fluoroscopy is used, and the facility owns the C-arm. The operating surgeon interprets the fluoroscopic spot images and dictates a separate written report. The surgeon bills the fluoroscopy code (e.g., 76000) with modifier 26; the ASC bills the same code with modifier TC.
A patient undergoes ORIF of a distal radius fracture (CPT 25600) at a hospital. Post-reduction radiographs are taken by hospital radiology staff. The treating orthopedic surgeon reviews the post-op films, confirms acceptable alignment in a signed report, and bills the wrist X-ray code (CPT 73100) with modifier 26; the hospital bills 73100-TC.
An MRI of the shoulder (CPT 73221) is ordered to evaluate a suspected rotator cuff tear. The imaging center performs and bills the technical component. The patient's orthopedic surgeon, credentialed to read musculoskeletal MRIs, provides a formal written interpretation and bills 73221-26 rather than asking a radiologist to read it.
A total knee arthroplasty (TKA) patient returns for a 6-week post-op visit; weight-bearing knee X-rays are taken at the hospital's outpatient imaging department. The orthopedic surgeon interprets the films during the visit and dictates a standalone written report. The surgeon bills the knee X-ray code with modifier 26; the hospital's radiology department bills modifier TC for the same code.

Common mistakes

Where coders most often go wrong with modifier 26.

Source · Editorial brief grounded in CMS NCCI Policy Manual and cited references ↓

Appending modifier 26 to professional-component-only CPT codes (PC/TC indicator 2, e.g., 93010)—these codes already bill only the interpretation; the modifier is redundant and triggers denial.
Billing modifier 26 for a re-read or second-opinion interpretation when another physician already billed the original professional component—payers treat the re-read as bundled into the global and will not separately reimburse it.
Using modifier 26 alongside modifier TC on the same claim line from the same provider—these modifiers are mutually exclusive; billing both signals the global service and the split simultaneously, causing a processing error.
Entering modifier 26 in the second or third modifier field instead of the first modifier field, which can cause automated claim edits to misread the billing intent and deny or pend the claim.
Submitting modifier 26 with an incorrect place of service—for example, listing POS 11 (office) when the imaging was performed at a hospital or freestanding facility; payers match the POS to where the technical component was rendered, and a mismatch leads to denial.
Attaching modifier 26 to E/M codes or anesthesia codes, which have no technical component by definition and are therefore ineligible for professional/technical splitting.
Billing modifier 26 on global-test-only codes such as CPT 93000 (routine ECG with interpretation), which represent a single bundled service that cannot be split.

CPT codes that use modifier 26

89 orthopedic CPT codes in our reference list this modifier as applicable. Sorted by total RVU.

Source · Derived from per-code modifier guidance in our CPT reference

Showing top 12 of 89 by total RVU.

Where modifier 26 shows up

Body regions where this modifier most commonly appears in our orthopedic reference.

Spine 19 codes
General 17 codes
Foot & ankle 10 codes
Shoulder 9 codes

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can the same physician bill both modifier 26 and modifier TC on the same claim?

No. Modifier 26 and modifier TC are mutually exclusive on a single claim line. If the physician performed both the technical and professional components, bill the global code with no modifier. Only split the components when two separate entities—typically a facility and an independent physician—each performed their respective portion.

02Does modifier 26 require a written report, or is a verbal finding sufficient?

A written, signed report is required. Payers, including Medicare, expect a standalone document describing the findings before the claim is submitted. A verbal communication to the ordering provider does not satisfy this requirement and exposes the claim to audit risk.

03Which place of service should the interpreting physician use when billing modifier 26?

The POS must reflect where the diagnostic study was performed—not where the physician physically sat when reading the images. If the CT was done in a hospital ED (POS 23), the interpreting physician's claim should show POS 23, even if the physician read the images remotely from an office.

04Can an orthopedic surgeon bill modifier 26 for reading post-op X-rays taken at a hospital?

Yes, provided the surgeon produces a separate, signed written report and the hospital is billing the technical component separately. If the X-ray interpretation is merely documented within the post-op office visit note without a standalone report, the professional component claim is unsupported.

05What is the PC/TC indicator, and why does it matter for modifier 26?

The PC/TC indicator is a field in the CMS Medicare Physician Fee Schedule Database that classifies each CPT code by how its components can be billed. Codes with indicator 1 can be split with modifier 26 or TC. Codes with indicator 2 are professional-component-only and must never have modifier 26 appended. Codes with indicator 0 are global-only and cannot be split at all.

06Is modifier 26 ever appropriate for pathology services in orthopedics?

Yes. When a bone or tissue specimen from an orthopedic procedure—such as a synovial biopsy or a resected bone tumor—is sent to an outside pathology lab, the laboratory provides the technical component and a pathologist provides the professional component. The pathologist bills the applicable pathology CPT code with modifier 26 if the technical and professional work are billed by separate entities.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

01AMA CPT Appendix A – Modifiers (professional component definition for modifier 26)
02CMS Medicare Physician Fee Schedule Database (MPFSDB) – PC/TC Indicator column
03CMS National Correct Coding Initiative (NCCI) Policy Manual – Chapter on modifier usage and mutually exclusive codes
04Novitas Solutions Medicare Contractor – Modifier 26 Fact Sheet: https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00094624
05AAPC Knowledge Center – When to Apply Modifiers 26 and TC: https://www.aapc.com/blog/52001-when-to-apply-modifiers-26-and-tc/
06Horizon Blue Cross Blue Shield of New Jersey – Appropriate Use of Modifier 26: https://www.horizonblue.com/providers/products-programs/evicore-health-care/radiology-imaging-services/appropriate-use-modifier-26
07Premera Blue Cross – Modifiers 26 and TC Professional & Technical Components Reimbursement Policy: https://www.premera.com/portals/provider/paymentpolicies/cmi_051715.pdf

Mira AI Scribe

When modifier 26 is appropriate, the AI scribe should ensure the physician's documentation includes a discrete, signed written report—not just an addendum buried in the office note. The report must state the study reviewed, the clinical indication, a description of findings, and the interpreting physician's signature. The place of service on the claim must match where the imaging equipment was physically located, not where the physician read the images. Flag any encounter where the physician interprets a study performed at a hospital or imaging center that the practice does not own: those scenarios almost always require modifier 26 on the professional bill and modifier TC on the facility bill. Do not auto-populate modifier 26 on CPT codes with a PC/TC indicator of 2 or on E/M codes—those are ineligible. Always prompt the physician to confirm a separate written report exists before the claim is finalized.

See how Mira flags modifier 26 in dictation