In radiology billing, almost every CPT code is split into two halves: the physical taking of the image, and the doctor reading it. If you only perform the reading, you must append Modifier 26.
What is Modifier 26?
Modifier 26 represents the Professional Component. You use this when a physician (like a radiologist or a specialist) reviews a scan and writes a formal interpretation and report, but they do NOT own the MRI or CT scanner.
If you bill the global code (no modifier) when you don't own the equipment, you are falsely claiming reimbursement for the technical overhead, which triggers severe Medicare audits.
Medical Necessity & The Report
To bill Modifier 26, there must be a distinct, written, signed report of the findings in the patient's medical record. A brief note saying "chest x-ray looks clear" in an E/M note is NOT sufficient to bill Modifier 26.
NCCI Edits
Never append Modifier 26 to codes that are inherently professional-only (e.g., E/M codes or surgical codes). Use our checker to verify PC/TC indicators.