Medicare Compliance & Reimbursement

Repeat service, but 2 different providers? There’s a modifier for that.

Do you know what to do if your provider performs the same service for the same patient more than once on a single date? If you report the corresponding CPT® codes on separate lines of your claim form without a modifier appended, you’re likely to get a denial for submitting a duplicate service. Your best bet? Adding the appropriate modifier to your code.

If your head spins when trying to pinpoint the right modifier to use for repeat services, check out five quick facts that can help you iron out the details.

1. Get the Definitions of Your Main Options

Before you can differentiate one modifier from another, get to know the three main options to consider:

• 76 (Repeat procedure or service by same physician or other qualified health care professional)
• 77 (Repeat procedure or service by another physician or other qualified health care professional)

Once you have these descriptors in front of you, it’s time to move on to the best ways to tell them apart.

2. Identify the Provider Who Performed the Service

The difference between modifier 76 and 77 is that you use modifier 76 when only one physician performs the procedures or services, and you use 77 when there is a second physician performing the subsequent procedure or service.

When you find that your physician repeats a procedure on the same date, look to see if there was a second physician before you make your modifier decision. When there are two physicians, they need to be in the same practice or group for the service to qualify as a repeat. If the two physicians are in different groups, you can simply report the code for the second physician’s service with no modifier.

3. Single Provider? Look to 76

Modifier 76 is your go-to choice when the same provider performs both procedures.

How you’ll list the codes on your claim form may depend on your payer.

For instance, according to a January 2024 Fact Sheet from Part B Medicare Administrative Contractor (MAC) Novitas Solutions, you should append modifier 76 to the code, along with the number of repeated services, on one claim line. “Do not report modifier 76 on multiple claim lines to avoid duplicate claim line denials,” Novitas says. “Bill all services performed on one day on the same claim, to avoid duplicate claim denials. Part B MAC >NGS Medicare also states, “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.”

However, when you’re billing more than two procedures, such as three instances of the same procedure, you’ll enter the applicable CPT^® code on line 1 without a modifier plus the CPT^® code on line 2 appended with modifier 76 and a number 2 in the units field.

4. Different Provider Warrants 77

You’ll use modifier 77 when one provider in your practice performs the first service and a separate provider performs the second. If you submit identical, duplicate services for the same date of service “by another performing provider with the same specialty within the billing group without the use of any modifier,” you’ll find your claim denied, according to February 2024 guidance from Blue Cross Blue Shield of North Dakota. This guidance seems to propose that both services can be reported on the same claim as long as both providers are in the same group and the same specialty. Two claims are required when providers are part of different groups and/or specialties.

Torrey Kim, Contributing Writer, Raleigh, N.C.