Last Modified: 8/12/2024
Location: FL, PR, USVI
Business: Part B
Modifier 76 used to report repeat procedure or service by same physician or other qualified health care professional 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 (lumbar or sacral, each additional facet joint) billed in addition to primary/principal code 64635, (lumbar or sacral, single facet joint) 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
• Use modifier 76 on a separate claim line with the number of repeated services.
• Do not report modifier 76 on multiple claim lines, to avoid duplicate claim line denials.
• Documentation must support the use of the modifier
A patient had two EKG services (CPT 93010) in the morning and one in the afternoon in the radiology department. Since the EKG services showed signs of clinical issues, they were billed to Medicare.
Date of Service (From-To) |
Procedure Code / Modifier |
Units |
02/21/2024 - 02/21/2024 |
93010 |
1 |
02/21/2024 - 02/21/2024 |
93010 - 76 |
2 |
Note: Submit the time each service was performed (e.g., 8:00 a.m., 10:15 a.m., and 1:45 p.m.) in the narrative description field item 19 of the CMS-1500 claim form or the EDI equivalent.
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