Avoiding Duplicate Denials When Billing with Modifier 76
Modifier 76 is defined by the Current Procedural Terminology as "repeat procedure by same physician." This modifier is appropriate when necessary to report repeat procedures performed on the same day.
Some providers have experienced denials when using a 76 modifier on more than one line of service to indicate multiple procedures billed on the same date of service by the same physician for the same beneficiary.
Example
| Line | Procedure | Modifier | Quantity | |
| 1 | 71275 | 1 | Paid | |
| 2 | 71275 | 76 | 1 | Paid |
| 3 | 71275 | 76 | 1 | Denied as duplicate |
To avoid a duplicate denial for the 3rd and subsequent lines, providers can indicate in Loop 2400 MEA segment for electronic claims or in item 19 of the CMS 1500 claim form, the total number of services performed that day. For example, "71275 performed 3 times on 10-12-07"
For certain services providers may also avoid unnecessary duplicate denials by quantity billing those services on a single claim line.
Example
| Line | Procedure | Modifier | Quantity | |
| 1 | 93010 | 3 | Paid |
Providers may contact Customer Service to verify whether a particular procedure may be quantity billed.
For additional information on modifier 76, please refer to the Modifier 76 Fact Sheet located on the WPS Medicare Website at the address listed below. http://www.wpsmedicare.com/mac/education/76.pdf
Page Last Updated: Wednesday, 31-Dec-2008 10:48:36 CST
