Modifier 26: the professional component of a service.

What modifier 26 means

Modifier 26 identifies the professional component (PC) of a service that has both a professional and a technical part. In CMS chapter 13 the PC of a radiology service is the physician’s interpretation, and CMS says “the interpretation of a diagnostic procedure includes a written report.” The technical component (TC) is the equipment, supplies and staff that produce the test, reported with modifier TC.

Medicare pays the PC of radiology services furnished by a physician to an individual patient in all settings under the physician fee schedule, regardless of the physician’s specialty (section 20.1). A claim line with neither modifier TC nor modifier 26 is the global service: both parts billed together.

Global versus split billing

Global billing is possible only when the same physician or supplier entity furnishes the TC and the PC, and both are furnished within the same Medicare physician fee schedule payment locality (section 150.D). If not, the interpreting physician bills the PC separately with modifier 26. CMS says merely applying the same POS code to the PC as to the TC does not permit global billing.

CMS chapter 13 section 150 also states how to complete the claim. For the interpretation, the interpreting physician reports the address and ZIP code of the location where the interpretation was furnished. If that location is unusual and infrequent, for example a hotel, the locality is based on the Medicare-enrolled location where the interpreting physician most commonly practices.

Which place of service code?

As a general policy, the POS code on the physician’s PC claim is the setting in which the beneficiary received the TC. CMS gives this example: a patient has an MRI on an outpatient hospital campus near home. The hospital bills the TC. The physician reads the MRI from an office. The physician’s claim uses POS 22 (On Campus-Outpatient Hospital), because that is where the face-to-face portion happened. For a TC performed under arrangement to a hospital, the physician uses POS 22 or POS 19 on the interpretation claim. If it is unclear which POS applies, CMS says the Medicare contractor can provide guidance. Look up any code with the place of service code lookup.

Other places CMS uses modifier 26

• Endoscopic ultrasound: chapter 12 says interpretation, whether by a radiologist or endoscopist, is reported under CPT 76975-26, and that it may be reported on the same day as the endoscopy code.
• Clinical laboratory interpretation: only interpretation services that meet the criteria in chapter 12 are billable under the fee schedule. They are reported under the clinical laboratory code with modifier 26 and have a PC/TC indicator of “6” on the Medicare Physician Fee Schedule database.
• PET oncologic claims: chapter 13 describes claims billed with modifiers 26 and KX for the professional component.

The review-versus-report limit

For emergency room x-rays and EKGs, CMS distinguishes an “interpretation and report” from a “review.” A PC billed for a review of findings, without a complete written report similar to one a specialist would prepare, does not meet the conditions for separate payment, since the review is already included in the emergency department E/M payment (section 100.1).

Worked example (hypothetical)

A freestanding imaging center performs a chest x-ray and bills the TC. A radiologist who works for a different group reads it and writes the report. Because different entities furnished the two components, the radiologist bills the PC with modifier 26. The POS on that claim is the setting where the patient had the x-ray, chosen from the CMS definitions. If one group owned both the machine and the reading radiologist and both were in the same locality, it could bill the global code with no modifier. Whether a particular code accepts modifier 26 depends on the fee schedule’s indicators for that code. Check the Physician Fee Schedule files.

Related modifiers

• Modifier 25: a separate E/M visit on procedure day.
• Modifier 59: a distinct procedural service.
• CARC 4: the denial code for a modifier that does not match the procedure.

Sources

• CMS: Medicare Claims Processing Manual, Chapter 13 (Rev. 13150, issued 04-11-25) — sections 20.1 and 150 (retrieved 2026-11-02)
• CMS: Medicare Claims Processing Manual, Chapter 12 (Rev. 13753, issued 05-07-26) — endoscopic ultrasound and clinical laboratory interpretation passages (retrieved 2026-11-02)
• CMS: Place of Service Code Set — official code list and descriptions, page database updated May 2, 2024 (retrieved 2026-11-02)
• CMS: Medicare Claims Processing Manual, Chapter 26 (Rev. 12779, issued 08-09-24) — sections 10.5 and 10.6, facility and non-facility designations and special considerations (retrieved 2026-11-02)

Every definition and rule above was read from these CMS pages on November 2, 2026. Payers revise code lists, contracts and policies, so confirm anything that affects a claim with the payer. CMS itself tells billers to check each payer (Medicare, Medicaid, private plans) for how it reimburses each code.