Modifier 26
CPT modifier indicating the professional component of a procedure.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Billing
- Primary sources
- 3
- Workspace handoff
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Where this comes up
This shows up in revenue-cycle work — claim scrubbing, charge entry, posting, A/R follow-up, and month-end close. Billers and practice managers hit this term when reconciling a payment, working a denial queue, or auditing why a claim aged past 60 days.
Full definition
What it is in practice
CMS recognizes modifier 26 for procedures with PC/TC splits in the PFS RVU file. The 26-modified line bills only the physician's interpretation or supervision portion.
How it shows up in your practice
Append 26 when billing the professional component only (e.g., reading an X-ray taken at a hospital). Confirm PC/TC eligibility before using.
Sources
- CMS — Physician Fee Schedulehttps://www.cms.gov/medicare/payment/fee-schedules/physician
- CMS — PFS Relative Value Fileshttps://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files
- CMS — Modifiershttps://www.cms.gov/medicare/coding-billing/modifiers
Verify modifier 26 use in Ask D3
Open ask d3 →Related terms
- BillingProfessional ComponentThe portion of a procedure code (designated by modifier 26) representing the physician's interpretation or supervision, separate from the technical component.
- BillingTechnical ComponentThe portion of a procedure code (designated by modifier TC) representing equipment, supplies, and technical staff used to perform a service.
- BillingFacility FeeA charge billed by a hospital or facility for the institutional resources used in providing a service, separate from the professional fee.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryFacility FeeA charge billed by a hospital or facility for the institutional resources used in providing a service, separate from the professional fee.
- GlossaryProfessional ComponentThe portion of a procedure code (designated by modifier 26) representing the physician's interpretation or supervision, separate from the technical component.
- GlossaryTechnical ComponentThe portion of a procedure code (designated by modifier TC) representing equipment, supplies, and technical staff used to perform a service.
- GlossaryModifier 22CPT modifier indicating increased procedural services requiring substantially greater work than usually required.
- GlossaryModifier 24CPT modifier indicating an unrelated E/M service performed by the same provider during a postoperative global period.
- GlossaryModifier 50CPT modifier indicating a bilateral procedure performed at the same operative session.
- GlossaryModifier 51CPT modifier indicating multiple procedures performed at the same session by the same provider.
- BillingAWV + Problem Visit Same Day: How to Bill CorrectlyYes, you can bill AWV and a problem visit the same day. Here's how to do it correctly with modifier -25.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.