Wiki 0042T--PROFESSIONAL ONLY??

[lawalls27]

In our company, modifier -26 is automatically appended by our system, except, sometimes, on CPT's that are Professional components only. Should 0042T (Cerebral CT Perfusion) have a mod -26 appended, or is this one of the Professional component only CPT's??

 

[Deborah Marsh]

Hi - 0042T is a physician services code. You should not use mod 26 on it. Here are the details:

The Medicare Physician Fee Schedule (https://www.cms.gov/Medicare/Medica...nt/PhysicianFeeSched/PFS-Relative-Value-Files) assigns PCTC indicator "0" to 0042T.

The definition of PCTC indicator "0" is: "Physician Service Codes--Identifies codes that describe physician services. Examples include visits, consultations, and surgical procedures. The concept of PC/TC does not apply since physician services cannot be split into professional and technical components. Modifiers 26 and TC cannot be used with these codes. The RVUS include values for physician work, practice expense and malpractice expense. There are some codes with no work RVUs."

The definitions are available in a PDF in the downloadable MPFS folder at that link above. It's worth a look because a lot of them say not to use 26/TC with the codes. Hope that's helpful!