Modifier 76 is defined as a repeat procedure or service by the same physician or other qualified healthcare professional.
Used to indicate a procedure or service was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
The same physician or other qualified healthcare professional performs the services.
Procedure codes that cannot be quantity billed.
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; refer to Current Procedural Terminology (CPT) 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/principle 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 76 to the subsequent procedures.
Documentation must support the use of the modifier.
A patient had two EKG services (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 |
Procedure Code |
Modifier |
Units |
02/21/2022 |
93010 |
- |
1 |
02/21/2022 |
93010 |
76 |
1 |
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 1500 claim form or the EDI equivalent.
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