- Anesthesia Modifiers
- Appropriate Usage of Modifier 99
- Assistants at Surgery at Teaching Hospitals
- Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission
- Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, TI-T9 and TA vs. Modifier 50
- Correct Usage of Modifier 79 for Multiple Procedures
- Co-Surgery/Team Surgery/Assistant Surgery Modifiers
- Modifier 25
- Modifier 33
- Modifier 51
- Modifier 52 Claim Submission Billing Reminder
- Modifier 59 and the Subset Modifiers XE, XP, XS, XU - Specific Modifiers for Distinct Procedural Services
- Modifier 90 Reference to Outside Laboratory
- Modifiers Used in CMS-1500 Claim Reporting
- Modifier Usage
- Proper Billing of Surgical Comanagement (Modifiers 54 and 55)
- Proper Use of Modifiers 59 and 91
- Reminder for Submission of Modifier 22
- Repeat Procedures - Modifiers 76 and 77
Repeat Procedures - Modifiers 76 and 77
Exact duplicate data fields submitted for claims include:
- Same beneficiary
- Same provider
- Same dates of service
- Same types of services
- Same place of service
- Same procedure codes
- Same billed amount
Therefore, issues may exist when valid repeat services are billed and not submitted correctly. For these claims the following modifiers are used:
- Modifier 76: Repeat procedure by the same physician
- Modifier 77: Repeat procedure by another physician
Modifier 76 indicates that a procedure or service was repeated on the same day by the same physician.
- The procedure code is listed once, and then listed again with modifier 76 added (two line items). The second line item will have the appropriate quantity billed amount.
Example: Physician orders a 71045 radiologic examination, chest; single view, frontal.
- First, 71045 performed at 8:00 a.m. by NPI 1
- Second, repeated at 1:00 p.m. by NPI 1
- Third, repeated at 3:00 p.m. by NPI 1
- Fourth, repeated at 6:00 p.m. by NPI 1
- Fifth, repeated at 10:00 p.m. by NPI 1
Below is what your claim should look like:
- Detailed line one: 71045 billed with 1 unit of service
- Detailed line two: 71045 76 with 4 units of service
In the example above there are a total of five chest X-rays by the same physician.
Modifier 77 indicates that a procedure had to be repeated by a different physician on the same day.
- The procedure code is listed once and then listed again with modifier 77 added (two line items). The second line item will have the appropriate quantity billed amount.
There will be times a procedure was repeated, but by a different physician; therefore, the above scenario would be different and would be reported differently.
Example: Physician orders a 71045 radiologic examination, chest; single view, frontal.
- First, 71045 performed at 8:00 a.m. by NPI 1
- Second, repeated at 1:00 p.m. by NPI 1
- Third, repeated at 3:00 p.m. by NPI 1
- Fourth, repeated at 6:00 p.m. by different NPI 2
- Fifth, repeated at 10:00 p.m. by different NPI 2
Below is ;what your claim should look like:
- Detailed line one: 71045 billed with 1 unit of service by NPI 1
- Detailed line two: 71045 76 with 2 units of service by same NPI 1
- Detailed line three: 71045 77 with 2 units of service by different NPI 2
In the example above there are a total of five chest X-rays; three by the same physician and two by a different physician.
Example: Procedure 93000 electrocardiogram, routine EKG with at least 12 leads, with interpretation and report. The 93000 is performed on a patient three times in a day.
- First, 93000 is performed at 9:30 a.m. by NPI 1
- Second, repeat at 3:30 p.m. by a different physician NPI 2
- Third, repeat at 8:30 p.m. by different physician NPI 2
The only difference is that the second and third EKG is ordered by a different physician.
Below is what your claim should look like:
- Detailed line one: 93000 billed with 1 unit of service by NPI 1
- Detailed line two: 93000 77 with 2 units of service by different NPI 2
Total of three EKGs; one by a physician and two by a different physician.
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Revised 9/28/2023