What does modifier -26 indicate in a pathology/laboratory test?

Modifier -26 is used in pathology and laboratory testing to indicate the professional component of a service. This modifier signifies that only the interpretation and reporting of the test results are being billed, rather than the technical component, which involves the actual laboratory work and analysis of the specimen.

In specific scenarios, a laboratory may perform both the technical and professional components of a service. When a provider only offers the professional component, they would use modifier -26 to clarify that their billing exclusively reflects the professional oversight, expertise, and interpretation of the test results.

This billing structure allows different entities such as hospitals and outside laboratories to separately bill for their respective services. In this context, it situates the provider's role in the broader process of patient care and diagnostic assessment, providing clarity for reimbursement and documentation purposes.