CurrentHealthy Blue LouisianaPolicy G-06018

Reimbursement Policy Modifier 76

Customize your policy alerts

Sign up for healthybluelouisiana Policy G-06018 alerts

Get alerted when Policy G-06018 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

This policy governs reimbursement when Modifier 76 is appended to a procedure or service repeated by the same physician or other qualified healthcare professional. It applies to participating providers and facilities submitting claims to Healthy Blue Louisiana, subject to applicable contracts, coding requirements, and member benefit coverage.

Policy Summary

PayerHealthy Blue Louisiana

PolicyReimbursement Policy Modifier 76

Policy CodePolicy G-06018

Change TypeAdministrative and definitional update

Effective DateJan 26, 2026

Next Review DateN/A

Key ActionSubmit supporting documentation with the claim when using Modifier 76.

SourceLink

POLICY UPDATE CHANGES

The Definitions section was updated to add a definition for Modifier 76.

100%Eligible nonsurgical reimbursement rate

2Maximum total surgical procedures

0Reimbursement without supporting documentation

3Excluded Modifier 76 use categories

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentHealthy Blue LouisianaPolicy G-06018

Reimbursement Policy Modifier 76

Customize your policy alerts

Sign up for healthybluelouisiana Policy G-06018 alerts

Get alerted when Policy G-06018 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerHealthy Blue Louisiana

PolicyReimbursement Policy Modifier 76

Policy CodePolicy G-06018

Change TypeAdministrative and definitional update

Effective DateJan 26, 2026

Next Review DateN/A

Key ActionSubmit supporting documentation with the claim when using Modifier 76.

SourceLink

POLICY UPDATE CHANGES

The Definitions section was updated to add a definition for Modifier 76.

100%Eligible nonsurgical reimbursement rate

2Maximum total surgical procedures

0Reimbursement without supporting documentation

3Excluded Modifier 76 use categories

Modifier 76 Reimbursement Criteria

Modifier 76 may be appended to an applicable procedure code when the same physician or other qualified health care professional repeats the procedure or service, subject to all criteria and exclusions below.

ALL of the following

The procedure or service is repeated by the same physician or other qualified health care professional after the original procedure or service.
Modifier 76 must not be appended to an evaluation and management (E/M) service.
The claim meets the applicable timing requirement
- For a professional provider claim, the repeated procedure or service is performed subsequent to the original procedure or service.
- For a facility claim, the repeated procedure or service is performed on the same date as the original procedure or service.
Modifier 76 is appended to an appropriate procedure code for the repeated service.
The provider submits supporting documentation for use of modifier 76 with the claim.
Professional services other than radiology are subject to clinical review for consideration of reimbursement. A claim submitted without supporting documentation is not eligible for reimbursement; the required documentation may be requested for reconsideration.
The procedure or service is repeated no more than once.最多 2 total procedures
The original procedure plus one repeat is the maximum. Modifier 76 is not reimbursable for any procedure repeated more than once.
The procedure type and applicable reimbursement rule are satisfied
- For a nonsurgical procedure or service, reimbursement is 100% of the applicable fee schedule or contracted/negotiated rate.
- For a surgical procedure, reimbursement is 100% of the applicable fee schedule or contracted/negotiated rate for the surgical component only, limited to a total of two surgical procedures.
  If the repeated surgical procedure is performed with an assistant surgeon or in conjunction with multiple surgeries, assistant surgeon and multiple procedure rules and fee reductions apply.
The claim does not involve an excluded use of modifier 76, including an inappropriate procedure code or the preoperative or postoperative component of a surgical procedure.

Modifier 76 Coding and Reimbursement Rules

Modifier 76Modifier

76	Modifier 76 indicates that a procedure or service was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.

Excluded service typeCPTNot Covered

E/M	Modifier 76 should not be appended to an evaluation and management service.

Nonsurgical Reimbursement Rate

Reimbursement rate100%

Applicable serviceNonsurgical procedure or service

Rate basisApplicable fee schedule or contracted/negotiated rate

Surgical Reimbursement Rate

Reimbursement rate100%

Applicable serviceSurgical procedure

Rate basisApplicable fee schedule or contracted/negotiated rate for the surgical component only

Maximum Repeated Surgical Procedures

MaximumTwo total surgical procedures

Reimbursable componentSurgical component only

Additional rulesAssistant surgeon and multiple procedure rules and fee reductions apply when applicable

Maximum Repeat Frequency

Maximum repeat frequencyOne repeat after the original procedure or service

Nonreimbursable frequencyModifier 76 is not reimbursable for a procedure repeated more than once

Other nonreimbursable useModifier 76 is not reimbursable with an inappropriate procedure code or for the preoperative or postoperative components of a surgical procedure

Provider Billing Actions

Billing Rule

Use Modifier 76 for eligible repeated services

Append Modifier 76 when a procedure or service is repeated by the same physician or qualified healthcare professional. For professional claims, the repeat must occur subsequent to the original procedure or service; for facility claims, it must occur on the same date as the original service.

Documentation Required

Submit supporting documentation

Submit supporting documentation with the claim when using Modifier 76. Claims submitted without supporting documentation are not eligible for reimbursement, although the required documentation may be submitted for reconsideration.

Denial Risk

Expect clinical review for applicable professional services

Professional services other than radiology are subject to clinical review for consideration of reimbursement. Ensure the claim and supporting documentation substantiate the repeated service.

Denial Risk

Avoid nonreimbursable Modifier 76 uses

Do not use Modifier 76 with an inappropriate procedure code, for a procedure repeated more than once, or for the preoperative or postoperative components of a surgical procedure. These uses are not eligible for reimbursement.

Billing Rule

Apply related surgical fee rules

When a repeated surgical procedure involves an assistant surgeon or is performed in conjunction with multiple surgeries, apply the applicable assistant surgeon and multiple procedure rules and fee reductions.

Policy Definitions

Modifier 76

Modifier 76Indicates that a procedure or service was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service

How to reportAdd Modifier 76 to the repeated procedure or service

E/M servicesModifier 76 should not be appended to an E/M service

General Reimbursement Policy Definitions

Definition setGeneral Reimbursement Policy Definitions

ApplicationGeneral reimbursement policy definitions apply

Policy contextDefinitions applicable to reimbursement policies