Modifier 26: Professional Component Billing Explained
Modifier 26 bills only the physician's interpretation of a test. Which codes accept it, how Medicare splits payment from TC, and when to bill globally instead.
Modifier 26 is a billing modifier that bills only the professional component of a diagnostic test: the physician's interpretation and written report, without the equipment, staff and supplies used to perform it. You use it when someone else, usually a hospital, owns the equipment and bills the technical side.
Key takeaways
- 26 works only on codes with a Medicare PC/TC indicator of 1, such as most imaging, echocardiography and many diagnostic tests.
- Reading a test for a hospital inpatient or outpatient? Bill the code with 26. The hospital is paid for the technical component.
- If your practice owns the equipment and reads the test, bill the global code with no modifier.
- The professional component pays the same in facility and non-facility settings.
- Codes that already describe only the interpretation, such as 93010, never take 26.
Modifier 26 · payment effect
With and without the modifier
71046 without 26 · national office
$33.07
Chest X-ray
71046-26 · Professional component
$10.02
Pays only the interpretation and report.
What modifier 26 means
Many diagnostic services have two parts. The technical component is the test itself: the machine, the technologist, the room, the supplies. The professional component is the physician reading the result and writing the report. When one entity does both, it bills the code with no modifier (the "global" service). When they're split, the reader bills with 26 and the performer bills with TC.
Medicare flags which codes can be split with the PC/TC indicator in the Physician Fee Schedule relative value file. Indicator 1 means the code has both components and modifiers 26 and TC can be used. Every other indicator means they can't.
CMS payment indicators · 71046
Chest X-ray
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
When to use modifier 26
- Hospital patients. A radiologist reads a chest X-ray (71046) for a hospital outpatient. Medicare pays the hospital for the technical component under the hospital's own payment system, and Part B contractors may not pay anyone else for it (Pub. 100-04, ch. 13, §20.2.1). The radiologist bills 71046-26.
- Outside reads. A cardiologist interprets an echocardiogram (93306) performed on another practice's or an imaging center's machine.
- Skilled nursing facility Part A stays. The SNF bills the technical side under consolidated billing; the reading physician bills 26.
When not to use modifier 26
Also skip 26 when your practice owns the equipment, employs the technologist and reads the study in the office. That's the global service: bill the code without a modifier. Billing 26 there leaves the technical payment unclaimed.
How modifier 26 affects payment
Medicare prices the global, professional and technical versions of a split code separately, each from its own relative value units:
- With 26: physician work RVUs plus a small practice expense and malpractice amount.
- With TC: practice expense and malpractice only, no physician work.
- Global (no modifier): all three, roughly the sum of the two parts.
The professional component is paid at the same rate whether the place of service is a facility or an office (Pub. 100-04, ch. 12, §20.4.2). For advanced imaging, codes with multiple procedure indicator 4 take a 5% reduction to the professional component of the second and later studies in the same family and session (RVU file, effective 2017 onward). The widget above shows the live split for 71046.
How the rate is built · 71046
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.21Practice expense 0.76Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Modifier 26 vs TC vs global
| Billing | Who bills it | What it pays |
|---|---|---|
| Code with no modifier (global) | One provider performs and interprets | Work, practice expense and malpractice |
| Code with 26 | The interpreting physician | Work plus a small PE and MP share |
| Code with TC | The owner of the equipment and staff | Practice expense and malpractice only |
| Interpretation-only code (e.g. 93010) | The interpreting physician | Already professional only; no modifier |
FAQ
What is the 26 modifier used for?
To bill the interpretation and report of a diagnostic test separately from the test itself, when a different entity owns the equipment and bills the technical component.
What is the difference between modifier 25 and 26?
They're unrelated. 25 goes on an E/M visit that was separate from a same-day procedure. 26 goes on a diagnostic test code to bill only the physician's interpretation. See modifier 25.
What is the difference between TC modifier and 26 modifier?
TC bills the technical part of a test (equipment, staff, supplies) and 26 bills the professional part (interpretation and report). Together they equal the global service. See modifier TC.
When not to use modifier 26?
When your practice performed and read the test with its own equipment (bill globally), when the code's PC/TC indicator isn't 1, and on codes that already describe only the interpretation.
Does modifier 26 pay less in a hospital?
No. Medicare pays the professional component at the same amount in facility and non-facility settings.
Keep reading
- Modifier TC, the technical half of the split.
- Modifier 76 for a repeat read of the same study on the same day.
- Modifier 52 when a test is reduced.
- Codes on this page: 71046 93306 93010 93005 93000
Sources: CMS National Physician Fee Schedule Relative Value File, CY 2026 (RVU26D), PC/TC and multiple procedure indicators; Medicare Claims Processing Manual, Pub. 100-04, ch. 12, §20.4.2, and ch. 13, §20.1–20.2.2. Verified October 6, 2026.
