CPT Modifier 26
Professional component only – Use to indicate that the physician component is reported separately from the technical component for the diagnostic procedure performed
CPT Modifier 90
Reference Lab – Used to indicate a lab test sent to an outside lab. e.g., lab procedure performed by a party other than the treating or reporting laboratory. NOTE: Outside lab name, address and UPIN must be included on the claim. Section 20 must be marked “yes” and your actual cost for each test, net any discounts, must be included in the charges section.
CPT Modifier GH
Diagnostic mammogram converted from screening mammogram on the same day.
CPT Modifier QP
Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a CPT
recognized panel other than automated profile codes
CPT Modifier QR
Repeat clinical diagnostic laboratory test performed on the same day to obtain subsequent reportable test value(s) (separate specimens taken in separate encounters)
CPT Modifier QW
CLIA waived test
CPT Modifier TC
Technical component only – Used to indicate that the technical component is reported separately from the professional component for the diagnostic procedure performed
