Modifier 76

Repeat procedure or service by same physician or other qualified health care professional

Instructions

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.

Correct Use

  • 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

Incorrect Use

  • Not appropriate with laboratory or pathology codes (append modifier 91)
  • Not appropriate to use with equipment failure
  • Should not be appended to an E/M service
  • Does not replace modifiers such as RT, LT, 50, E1-E4, FA, F1-F9, TA, and T1-T9

Claim Example - Two Chest X-Rays

This image shows CPT 71010 billed on two lines with one unit on each. There is no modifier on the first line; however, modifier 76 has been appended to line two.

Correct Claim Example - Three Chest X-Rays

This image shows CPT 71010 billed on one line with three units of service.

Incorrect Claim Example – Three Chest X-Rays

In this example, line three will deny as an exact duplicate of line two.

This image shows CPT 71010 billed on three lines with one unit on each. There is no modifier on the first line; however, modifier 76 has been added to lines two and three.

Resource

 

Last Updated Fri, 24 Sep 2021 17:46:24 +0000