CurrentHighmark Blue Cross Blue Shield WnyPolicy G-06019

Modifier 77 reimbursement

This policy governs reimbursement rules for claims billed with Modifier 77 (repeat procedure by another physician) for Highmark BCBS MMC, HARP, Child Health Plus, and Essential Plan members and applies to professional and facility claims as described.

Policy Summary

PayerHighmark Blue Cross Blue Shield Wny

PolicyModifier 77 reimbursement

Policy CodePolicy G-06019

Change TypeTemplate and references updated (non-material)

Effective DateNov 7, 2016

Next Review Date

Key ActionPhysicians must submit supporting documentation with the claim when using Modifier 77; claims without documentation will be denied.

SourceLink

POLICY UPDATE CHANGES

Updated policy template; removed 'Repeat Procedure by Another Physician or other Qualified Health Care Professional' from the policy title; removed 'subsequent' definition.

References and Material and Related Policies sections updated.

Policy language updated and approved 11/07/2016.

100%nonsurgical reimbursement

100% (component)surgical reimbursement

2max surgical repeats

2016-11-07effective date

2023-08-28last review

Modifier 77 Coverage Criteria

Modifier 77 coverage criteria

Highmark BCBS allows reimbursement for procedures appended with Modifier 77 under these conditions:

Reimbursement allowed when Modifier 77 indicates a procedure was repeated by another physician: subsequent to the original procedure or service for professional claims, or on the same date as the original procedure or service for facility claims.

Nonsurgical procedures: For a nonsurgical procedure or service: reimbursed at 100% of the applicable fee schedule or contracted/negotiated rate.

Surgical procedures: For a surgical procedure: reimbursed at 100% of the applicable fee schedule or contracted/negotiated rate for the surgical component only, limited to two surgical procedures.

Physicians must submit supporting documentation with the claim when using Modifier 77; claims submitted without supporting documentation will be denied and physicians will be asked to submit documentation for reconsideration.

Policy Summary

PayerHighmark Blue Cross Blue Shield Wny

PolicyModifier 77 reimbursement

Policy CodePolicy G-06019

Change TypeTemplate and references updated (non-material)

Effective DateNov 7, 2016

Next Review Date

Key ActionPhysicians must submit supporting documentation with the claim when using Modifier 77; claims without documentation 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.

Documentation and Review Requirements for Providers

Documentation Required

Submit supporting documentation with the claim (Modifier 77)

Physicians must submit supporting documentation for the use of Modifier 77 with the claim. If a claim is submitted with Modifier 77 without supporting documentation, the claim will be denied and physicians will be asked to submit the required documentation for reconsideration of reimbursement.

Submit documentation that shows the procedure was repeated by another physician as claimed.
If denied for lack of documentation, respond with the requested records to initiate reconsideration.

Denial Risk

Clinical review required for non‑radiology professional services using Modifier 77

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

Be prepared to supply clinical rationale and records to support the repeat service when requested.
Understand that radiology services are excluded from this specific clinical review requirement.

OpenPayer

Modifier 77 reimbursement

Modifier 77 Coverage Criteria

Coding and Reimbursement Limits

Documentation and Review Requirements for Providers

Key Definitions