Modifier 76: Appropriate Use
Modifier 76 Description
Used to indicate a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. As per Medicare when two physicians in the same group with the same specialty performing repeat services on the same day are considered as the same physician. Then we have to append modifier 76 with the subsequent repeat procedure within the same day.
- Procedure or service is performed on the same day
- Append 76 modifier to the repeated procedure or service CPT code only
- Used for surgeries, x-rays and injections
- Adding to each line of service
- Adding to a surgical procedure code;
- Staged procedures (modifier 58),
- Unplanned return to operating room (modifier 78)
- Unrelated procedure or service (modifier 79).
- Repeat services due to equipment / technical failure
- Repeat laboratory services; refer to Current Procedural Terminology (CPT) modifier 91
- Services repeated for quality control purposes
- A service or procedure was provided more than once; unusual events occurred
- Do not report this modifier with ‘add-on’ codes denoted in CPT with a “+” sign. If a service defined as an ‘add-on’ code is repeated or provided more than once (based on description) on the same day by the same provider, report the ‘add-on’ code on one line with a multiplier in the unit field to indicate how many times that service was performed.
- For example, CPT 64636 (each additional facet joint) (billed in addition to primary/principle code 64635) is reported on one line as: 64636, units equal 3 (or the total number of additional facet joints (not bilateral) in addition to the initial/single facet joint billed under CPT code 64635). In this example, follow CPT instruction if provided bilaterally.
Claim Example – Two Chest X-Rays
Correct Claim Example – Three Chest X-Rays
Incorrect Claim Example – Three Chest X-Rays
Modifiers © Copyright 2021 American Medical Association
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