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Modifier 76 Fact Sheet

Definition

  • Repeat Procedure by the Same Physician; use when it is necessary to report repeat procedures performed on the same day.

Appropriate Usage

  • On procedure codes that cannot be quantity billed
  • Report each service on a separate line, using a quantity of one and append 76 to the subsequent procedures
  • The same physician performs the services

Inappropriate Usage

  • Appending to a surgical procedure code
  • Appending to each line of service
  • Repeat services due to equipment or other technical failure
  • For services repeated for quality control purposes

Additional Information

  • Medicare considers two physicians, in the same group with the same specialty performing services on the same day as the same physician
  • For all procedure codes that cannot be quantity billed, always use a quantity of "1"
  • To avoid denials, bill all services performed on one day on the same claim
  • For repeat clinical diagnostic laboratory tests, use modifier 91 if the service cannot be quantity billed
  • Indicate in the electronic narrative record or Box 19 of the CMS 1500 claim form, the total number of services performed that day

Example

A second radiology service performed on the same day.

Modifier 76 Sample

Two subsequent services, with no original service.

Modifier 76 Denied

Page Last Updated: Wednesday, 26-Nov-2014 12:30:20 CST