Wiki Modifier 26 in POS 81

[dschic]

Hi, I am having some trouble with billing modifier 26 to Medicare plans in POS 81. Some say the rendering provider is required to be on the claim, while others say only the supplier information is required. Does anyone know if the rendering provider's information should be billed in box 24J when billing the professional component of a lab test?

 

[thomas7331]

Any time you're billing for a professional service then the NPI of the physician performing the interpretation should be in box 24J. I'd just mention though that the only lab services that have a professional component are pathology services - Medicare does not recognize the 26 modifier for clinical lab tests. If you're billing Medicare a 26 modifier on non-pathology lab services, then that could be part of your problem.