Modifier 76: Modifier 76 indicates a repeat procedure performed by the same physician. Should only be submitted when the same health care professional repeats a process on the same date of service.
Modifier 76 Description
When a process or service is repeated by the same physician or other competent health care professional after the following procedure or service, it is referred to as a repeat process or service. When two physicians in the same group with the same specialty operate repeat offerings on the same day, Medicare considers them the same physician. Then, we must append modifier 76 to the subsequent repeat process within the same day.
Correct application
The process or service is completed on the same day.
Append the modifier 76 to the repetitive process or service.
It is used in surgeries, x-rays, and infusions.
Wrong application
- Adding to each service area.
- Adding a code to a surgical procedure.
- An unexpected return to the operating room.
- Procedure or service that is unconnected (modifier 79).
- Services must be repeated due to equipment or technical fault.
- Refer to Current Procedural Terminology (CPT) modifier 91 to repeat laboratory services.
- Services are replicated for quality assurance reasons.
- A service or process was rendered more than once; unexpected occurrences occurred.
This modifier should not be reported with ‘add-on’ codes signified in CPT by a “+” sign. If the same supplier repeats or provides a service defined as an ‘add-on’ code multiple times (based on description) on the same day, reveal the ‘add-on’ code on one connection with a multiplier in the unit field to imply how many times that service was conducted.
CPT 64636 (billed in addition to the primary code 64635), for example, is noted on one line as 64636, units equal 3 (or the total number of additional facet joints (not bilateral) charged in addition to the initial facet joint charged under CPT code 64635). In this case, if CPT instruction is supplied bilaterally, follow it.
Non-reimbursable
BCBSGA Medicare Advantage does not cover the use of Modifier 76:
- With an improper procedure code (e.g., laboratory/pathology).
- For a surgical procedure that has been performed more than once.
- For preoperative or postoperative elements of a surgical procedure.
- Following the original process or service, it may be essential to clarify that it was replicated by the same physician or other qualified health care professional. To indicate this situation, modifier 76 should be added to the repetitive procedure or service.
Recommendations and Guidelines
Submit this modifier to imply that a process or service was replicated after the original procedure or service was completed.
To differentiate these services from duplicate billing circumstances, this modifier may be submitted with multiple EKG understandings conducted for the same patient on the same date of service. Please provide the time each service was performed.
Submit this modifier and the ambulance transportation code (HCPCS codes A0425 through A0999) to imply that the same patient has received a second trip on the same date of service with the same origin/destination modifiers.
Still, have questions about how to use Modifier 76 correctly? Don’t worry; Billing executive services has a skilled coding team that employs precise modifiers to prevent denials. To learn more about our medical billing services, please contact us at rcmexpertz@Gmail.com
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