CurrentPremera BluecrossPolicy N/A

Modifier 76 (Repeat Procedure by Same Provider)

Defines Premera Blue Cross's recognition and reimbursement rules for claims that append modifier 76 to indicate a repeat identical service/procedure by the same provider; applies to professional claims (CMS-1500/837P) across Premera lines of business and affiliated plans.

Policy Summary

PayerPremera Bluecross

PolicyModifier 76 (Repeat Procedure by Same Provider)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 7, 2025

Next Review DateN/A

Key ActionAppend modifier 76 to the second claim line when the same identical procedure is repeated by the same provider and ensure the medical record documents the need for the repeat.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

professionalClaim form type governed

lab/pathCode categories excluded

77/78/79/91/58Modifiers not to combine

requiredMedical record requirement

When Modifier 76 Is Recognized

Modifier 76 coverage criteria

Covered when ALL of the following are met:

ALL of the following

The same identical service/procedure must be repeated by the same physician or qualified healthcare professional for the same patient.
Medical record must document the need to repeat the identical service/procedure.
If the repeated procedure is performed on the same date of service as the original, bill both procedures on the same claim and append modifier 76 to the second claim line; units on the second line should reflect the number of repeated services.
Modifier 76 must not be appended to surgical procedure codes that, by description, already indicate multiple procedures on the same date of service.

Policy Summary

PayerPremera Bluecross

PolicyModifier 76 (Repeat Procedure by Same Provider)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 7, 2025

Next Review DateN/A

Key ActionAppend modifier 76 to the second claim line when the same identical procedure is repeated by the same provider and ensure the medical record documents the need for the repeat.

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.

Billing and Documentation Requirements

Billing Rule

Modifier 76 billing and documentation

Append Modifier 76 on the second line when the same provider repeats the identical service/procedure (same CPT/HCPCS code) for the same patient. When billed on the same claim, place the original procedure on the first claim line and the repeated procedure on a subsequent line with Modifier 76; set the units on the second line to reflect the number of repeated services. Maintain complete medical record documentation that explains the clinical need to repeat the identical service/procedure by the same physician or other qualified healthcare professional. Modifier 76 is not appropriate for surgical codes that by definition already indicate multiple procedures on the same date of service. Modifier 76 must not be used if the repeat procedure was planned or staged.

When billing on the same claim: list original procedure first, append Modifier 76 to the identical procedure on the second claim line.
Units on the second line with Modifier 76 should represent number of repeated services.
Include documentation in the medical record justifying the repeat (reason, timing, provider identity).
Do not append Modifier 76 to surgical codes that inherently indicate multiple procedures on the same date.

Denial Risk

Prohibited uses and alternatives

Do not use Modifier 76 for planned/staged repeats, for repeats by a different provider, for repeat clinical laboratory tests, for unplanned returns to the OR, or for unrelated postoperative procedures. Use the alternative modifiers below as appropriate to accurately represent the clinical and billing circumstance.

Planned or staged repeat procedures: do NOT use Modifier 76 — append Modifier 58 (Staged or Related Procedure or Service by Same Physician or Other Qualified Healthcare Professional during Postoperative Period).
Repeat procedure performed by another provider: do NOT use Modifier 76 — append Modifier 77 (Repeat Procedure by Another Provider).
Unplanned return to the operating room for a related procedure: do NOT use Modifier 76 — append Modifier 78.
Unrelated procedure/service by same provider during postoperative period: do NOT use Modifier 76 — append Modifier 79.
Repeat clinical diagnostic laboratory tests: do NOT use Modifier 76 — append Modifier 91 (Repeat Clinical Diagnostic Laboratory Test) when applicable.
Evaluation and Management (E&M) codes: Modifier 76 is not appropriate for E&M submissions; use standard E&M reporting guidelines.

Modifier Definitions and Distinctions

Modifier 76 — Repeat Procedure by the Same Provider

DefinitionModifier 76 — Repeat Procedure by the Same Provider: appended to a service/procedure to indicate the same identical service/procedure was repeated subsequent to the original service/procedure by the same physician or other qualified healthcare professional for the same patient (often during the global period).

Billing instructionIf repeated on the same claim, bill both procedures on the same claim and append modifier 76 to the second procedure line; the units on the second line should represent the number of repeated services.

Documentation requirementMedical record must document the need to repeat the identical service/procedure to support reimbursement.

Not appropriate for surgical codes indicating multiple proceduresModifier 76 is not appropriate to append on surgical codes that by description already indicate multiple procedures on the same date of service.

Not valid with certain other modifiersDo not append modifier 76 to the same procedure code already appended with modifiers 77, 78, or 79 (or when modifier 58/91 applies).

Modifier 77 — Repeat Procedure by Another Provider

DefinitionModifier 77 — Repeat Procedure by Another Provider: used when the same service/procedure is repeated by a different physician or qualified healthcare provider.

When to useAppend modifier 77 (not 76) when the repeated identical procedure is performed by a different provider to be eligible for reimbursement.

Relationship to Modifier 76Modifier 77 must be used instead of modifier 76 when the repeating provider is different from the original performing provider.

Cross-referenceListed in cross-reference with Global Surgery, Modifier 58, 78, 79, and 91 in policy guidance.

Modifier 58 — Staged or Related Procedure

DefinitionModifier 58 — Staged or Related Procedure or Service by Same Physician during Postoperative Period: used for previously planned or staged repeats of a procedure by the same physician or qualified healthcare professional.

When to useUse modifier 58 when the repeated procedure was previously planned or staged to be repeated at a later time instead of appending modifier 76.

Relationship to Modifier 76Modifier 58 should be appended rather than modifier 76 when the repeat was planned/staged; modifier 76 is for unplanned repeats of the identical procedure by the same provider.

Cross-referencePolicy cross-references Global Surgery and other modifiers (77, 78, 79, 91) for related guidance.

Modifier 91 — Repeat Clinical Diagnostic Laboratory Test

DefinitionModifier 91 — Repeat Clinical Diagnostic Laboratory Test: used to indicate repeat clinical diagnostic laboratory tests rather than using modifier 76.

When to useAppend modifier 91 on repeat clinical diagnostic laboratory tests; do not append modifier 76 for repeat lab tests.

ExclusionModifier 76 is not appropriate for Pathology/Laboratory or Proprietary Lab Analysis codes; use modifier 91 when applicable.

Relationship to other modifiersDo not combine modifier 91 with modifier 76 for the same procedure; each has distinct use cases per policy.

OpenPayer

Modifier 76 (Repeat Procedure by Same Provider)

When Modifier 76 Is Recognized

Referenced Modifiers and Coding Notes

Billing and Documentation Requirements

Modifier Definitions and Distinctions

76	Repeat Procedure by the Same Provider
77	Repeat Procedure by Another Provider
78	Unplanned return to the Operating Room for a Related Procedure
79	Unrelated Procedure/Service by Same Provider during Postoperative Period
58	Staged or Related Procedure or Service by Same Physician or Other Qualified Healthcare Professional during Postoperative Period
91	Repeat Clinical Diagnostic Laboratory Test