Modifier 26

[Guest SG]

I believe in 1996 the Federal Register published a list of those CPT codes that should not have an allowable modifier 26 billed (ie, all automated lab tests). There is an employee at my organization who now claims that we must pay for all billed modifier 26's. Has this law changed? If so, please give me the Federal Register date of this change so that I may look it up. Thank you.

[Guest SG]

Shall I assume that "no answers" means that no one else has heard of any changes?

[Guest llerner]

I just read this today. Do you mean that it has been determined that these have been unbundled inappropriately? If so, they would have to paid as part of the main service and the employee should not be balanced billed if federal regs say that modifier to CPT code (26)is "padding" the bill. I'm not an expert on this reg at all but that seems logical. I would do a search on benefitslink or federal register if you want more detailed information. You might discuss this with the insurer since they should know of any regs that impact claims processing. I hope this helps.