CPT Modifier
Modifier 26 – Professional Component
What This Modifier Means
Reports only the physician or qualified provider’s interpretation and report of a service.
When to Use It
-
Provider performs interpretation and report only
-
Facility owns equipment and supplies
-
Radiology, cardiology, diagnostic testing
When NOT to Use It
-
Same entity performed both professional and technical components
-
No signed interpretation or report
Common CPT Code Examples
-
71045-26 Chest X-ray interpretation
-
93010-26 ECG interpretation
-
93306-26 Echocardiogram interpretation
Documentation Requirements
-
Separate signed interpretation
-
Distinct report
-
Clear provider attribution
Common Denials & Fixes
-
Denied as inclusive → Verify facility billed TC, not global
-
No report on file → Ensure interpretation is documented and signed
Related Modifiers
-
TC Technical Component
Quick Reference Box
Used when only the professional work is performed.
Modifier TC – Technical Component
What This Modifier Means
Reports equipment, supplies, and technical staff associated with a service.
When to Use It
-
Facility provides equipment and technical resources only
-
Diagnostic testing environments
When NOT to Use It
-
Billing professional interpretation
-
Global service billing
Common CPT Code Examples
-
70551-TC MRI brain technical component
Documentation Requirements
-
Proof of technical resources
-
Facility charge documentation
Common Denials & Fixes
-
Duplicate billing → Confirm no global code was submitted
Related Modifiers
-
26 Professional Component
Quick Reference Box
Used when billing technical services only.
Modifier 22 – Increased Procedural Services
What This Modifier Means
Indicates substantially greater work than typically required.
When to Use It
-
Increased time, complexity, or risk
-
Unusual anatomy or complications
When NOT to Use It
-
Routine complexity
-
Poor or vague documentation
Common CPT Code Examples
-
Complex surgical cases requiring extended effort
Documentation Requirements
-
Detailed operative note
-
Clear explanation of increased work
Common Denials & Fixes
-
No additional payment → Submit supporting documentation and cover letter
Related Modifiers
-
52 Reduced Services
Quick Reference Box
Requires strong narrative documentation.
Modifier 52 – Reduced Services
What This Modifier Means
Indicates a service was partially reduced.
When to Use It
-
Planned service not fully performed
-
Reduction not due to patient safety stop
When NOT to Use It
-
Service discontinued for patient safety (use 53)
Common CPT Code Examples
-
Diagnostic procedures partially completed
Documentation Requirements
-
What portion was completed
-
Why service was reduced
Common Denials & Fixes
-
Lack of clarity → Clearly define completed vs omitted portions
Related Modifiers
-
22 Increased Services
Quick Reference Box
Used when service is intentionally reduced.
Modifier 53 – Discontinued Procedure
What This Modifier Means
Reports a procedure started but stopped due to patient safety or condition.
When to Use It
-
Procedure halted after initiation
-
Patient instability or safety concerns
When NOT to Use It
-
Elective reduction (use 52)
Common CPT Code Examples
-
Procedures stopped mid-performance
Documentation Requirements
-
Reason for discontinuation
-
Point at which procedure stopped
Common Denials & Fixes
-
Improper modifier use → Confirm patient safety was the cause
Related Modifiers
-
52 Reduced Services
Quick Reference Box
Used when procedure is terminated for safety.
Modifier 73 / 74 – Discontinued Outpatient Procedures (Facility)
What These Modifiers Mean
Facility-only modifiers for discontinued outpatient procedures.
When to Use Them
-
73: Discontinued prior to anesthesia
-
74: Discontinued after anesthesia
When NOT to Use Them
-
Professional claims
-
Non-facility billing
Common CPT Code Examples
-
ASC and hospital outpatient procedures
Documentation Requirements
-
Anesthesia status
-
Reason for discontinuation
Common Denials & Fixes
-
Wrong modifier → Confirm anesthesia timing
Related Modifiers
-
53 Discontinued Procedure
Quick Reference Box
Facility-only discontinued procedure modifiers.