Last Modified: 9/18/2023
Location: FL, PR, USVI
Business: Part B
Modifier 76 used to report procedures or services that are performed in a separate operative session on the same day or separate encounter on the same day.
• The same physician or other qualified healthcare professional performs the services
• Procedure codes that cannot be quantity billed
It is not appropriate to use when:
• 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; (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/principal 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.
If performing repeat procedures on the same day:
• Bill all services performed on one day on the same claim
• Report each service on a separate line, using a quantity of one and append modifier 76 to the subsequent procedures
• Documentation must support the use of the modifier
A patient had two EKG services (CPT 93010) in the morning in the radiology department. Since both EKG services showed signs of clinical issues, they were both billed to Medicare.
Date of Service (From-To)
Procedure Code / Modifier
02/21/2023 - 02/21/2023
02/21/2023 - 02/21/2023
93010 - 76
Note: Submit the time each service was performed (e.g., 8:00 a.m. and 10:15 a.m.) in the narrative description field item 19 of the CMS1500 claim form or the EDI equivalent.
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