CurrentBlue Cross Blue Shield - MainePolicy G-06019

Modifier 77 — Repeat Procedure Reimbursement

Defines billing and reimbursement rules for claims using Modifier 77 (procedure repeated by another physician) for AMH Health/Blue Cross Blue Shield - Maine members, affecting professional and facility providers submitting claims.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyModifier 77 — Repeat Procedure Reimbursement

Policy CodePolicy G-06019

Change TypeNo material changes

Effective DateJan 1, 2020

Next Review Date

Key ActionProviders must submit supporting documentation with claims billed with Modifier 77 or the claim will be denied.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

100%reimbursement rate (surgical & nonsurgical)

2max reimbursable repeated surgeries

denialdenial if no documentation

disallowednon-reimbursable uses

08/28/2023last review

Modifier 77 Coverage Criteria

Modifier 77 coverage criteria

Reimbursement and exclusions for services billed with Modifier 77.

For reimbursement when Modifier 77 is used, the following apply:

Reimbursement rules

Surgical procedure: reimburse at 100% of the applicable fee schedule or contracted/negotiated rate for the surgical component only; limited to a total of two surgical procedures.
Nonsurgical procedure or service: reimburse at 100% of the applicable fee schedule or contracted/negotiated rate.

Applies to professional and facility claims as specified; for facility claims, Modifier 77 may be used when the repeated procedure occurs on the same date as the original procedure or service.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyModifier 77 — Repeat Procedure Reimbursement

Policy CodePolicy G-06019

Change TypeNo material changes

Effective DateJan 1, 2020

Next Review Date

Key ActionProviders must submit supporting documentation with claims billed with Modifier 77 or the claim will be denied.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coding Rules and Limits for Modifier 77

Modifier rulesModifier

Modifier 77

Repeat procedure by another physician

Maximum reimbursable repeated surgical procedures — limit and reimbursement rate

Maximum number of reimbursable repeated surgical proceduresLimited to a total of two surgical procedures when reimbursed at 100% of the surgical component (applicable fee schedule or contracted/negotiated rate)

Reimbursement rate for nonsurgical repeated procedures100% of the applicable fee schedule or contracted/negotiated rate

Scope of applicationApplies to professional and facility claims as specified (facility: may be on same date as original procedure)

Assistant surgeon and multiple procedure rulesIf a repeated surgical procedure involves an assistant surgeon or occurs with multiple surgeries, assistant surgeon and/or multiple procedure rules and fee reductions apply

Documentation and Clinical Review Requirements

Documentation Required

Submit supporting documentation with Modifier 77

Providers must include supporting documentation with any claim that includes Modifier 77. Claims submitted with Modifier 77 without supporting documentation will be denied and providers will be asked to submit the required documentation for reconsideration.

Include documentation demonstrating the procedure was repeated by another physician.
If documentation is not provided, the claim will be denied and reconsideration requires submission of the requested documentation.

Denial Risk

Clinical review required for non-radiology professional services with Modifier 77

Professional services (other than radiology) billed with Modifier 77 are subject to clinical review before reimbursement will be considered.

Expect clinical review of professional (non-radiology) claims that include Modifier 77.
Reimbursement determination for these services will depend on the outcome of that review.

Definitions and Non-reimbursable Uses

Modifier 77 — definition indicating a procedure was repeated by another physician

DefinitionModifier 77 indicates a procedure or service was repeated by another physician (used to report a subsequent procedure to the original)

Typical useAppended to applicable procedure codes to indicate the procedure was repeated by a different physician

Documentation requirementSupporting documentation must be submitted with the claim when Modifier 77 is used; absence of documentation will result in denial

Non-reimbursable uses — examples of inappropriate uses

Inappropriate procedure codesModifier 77 is not reimbursable when appended to an inappropriate procedure code

Preoperative or postoperative componentsNot reimbursable when used for the preoperative or postoperative components of a surgical procedure

Repeated more than onceNot reimbursable for any procedure repeated more than once

Evaluation and management (E/M) codesModifier 77 is not reimbursable when appended to evaluation and management (E/M) codes