Please note this question was answered in 2020. The coding advice may or may not be outdated.
Modifier 26 for hospital-based procedures
Date: Nov 6, 2020
Question:
We are an IR group contracted by the hospital and perform procedures in the hospital setting. If a physician does not append a CPT code that is eligible for a modifier -26, will this code get denied by insurance? For example, if a paracentesis is planned, but limited ultrasound shows no fluid and images were permanently stored, would we get reimbursed for code 76705, or would it need to be 76705-26? Is there a list of procedures that require modifier -26 for reimbursement?
Need to ask Dr.Z?
Don't see the answer you're looking for in the knowledge base? No problem. You can ask Dr. Z directly!Ask Dr. Z a question now!