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26.4.2.2 Modifier 76
Modifier 76 is limited as follows:
• Modifier 76 must not be used when billing the initial procedure. It must be used to indicate the repeated non-clinical procedure.
•If more than two services are billed on the same day by the same provider, regardless of the use of modifier 76, the claim or detail is denied.
•If a repeated procedure performed by the same provider on the same day is billed without modifier 76, it is denied as a duplicate procedure.
•If a claim is denied for a quantity more than two or as a duplicate procedure, the times of these procedures/services must be documented on appeal.
•Modifier 76 is not required and must not be used when billing multiple quantities of a supply (e.g., disposable diapers or sterile saline).
Certain procedure codes have been removed from modifier 76 auditing for dates of service on or after April 3, 1998. These procedure codes have been identified as routinely being performed at the same time, more than twice per day for each antigen (e.g., agglutinins, febrile [e.g., Brucella, Francisella, Murine typhus, Q fever, Rocky Mountain spotted fever, scrub typhus], each antigen). Providers may still appeal claims that have been denied for documentation of time. Most procedure codes initially requiring modifier 76 will continue to be audited for modifier 76.
When appealing claims with modifier 76 for repeat procedures, providers must separate the details. One detail should be appealed without the modifier and one detail with the modifier, including documentation of times for each repeated procedure.
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