Modifier 76: Repeat Procedure by Same Physician
Modifier 76 is used when the same procedure is repeated by the same physician on the same day. Learn how to document and bill repeat procedures correctly.
When to Append Modifier 76
Append to a procedure code when the same physician performs the same procedure a second time on the same day or during the same episode. Distinguishes a legitimate repeat service from a billing duplicate.
- Clinical notes must document the medical reason the procedure was performed twice.
- Without documentation, the claim will be treated as a duplicate submission.
Source: AMA CPT® Modifier Guidelines / CMS
Modifier 76 in Detail
What does Modifier 76 cover in detail?
Modifier 76 is appended when the same procedure is repeated by the same physician on the same day or in a subsequent encounter, signaling to the payer that this is not a duplicate claim.
It is most commonly applied in surgical billing contexts and is covered in full in the billing modifiers reference.
Using Modifier 76 Correctly
How do I use Modifier 76 correctly?
When to Apply
Apply this modifier only when the clinical circumstances described in the modifier definition are present and documented in the medical record.
Procedure Code Compatibility
Confirm this modifier is applicable to the procedure codes being billed. Not all modifiers are valid with all CPT codes.
Documentation Support
Ensure the medical record supports the modifier's use. Auditors will review documentation to confirm the modifier is appropriate.
Payer Acceptance
Verify that the payer accepts this modifier and understand how it affects reimbursement before submitting the claim.
Modifier 76 Reference
| Field | Details |
|---|---|
| Modifier | 76 |
| Full Name | Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional |
| When to Use | Append to a procedure code when the same physician performs the same procedure a second time on the same day or during the same episode. Distinguishes a legitimate repeat service from a billing duplicate. |
| Documentation Requirement | Clinical notes must document the medical reason the procedure was performed twice. Without documentation, the claim will be treated as a duplicate submission. |
| Common Payer Rule | Many payers require modifier 76 (or 77 for different physician) to process a same-day duplicate procedure claim. Without it, the second claim is denied as a duplicate. |
| Difference from Modifier 77 | Modifier 77 is used when a repeat procedure is performed by a different physician. Use 76 when the same physician repeats the service. |
Source: AMA CPT® Modifier Guidelines / CMS
Related Billing Resources
Modifier 76, Frequently Asked Questions
Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Append to a procedure code when the same physician performs the same procedure a second time on the same day or during the same episode. Distinguishes a legitimate repeat service from a billing duplicate.
Clinical notes must document the medical reason the procedure was performed twice. Without documentation, the claim will be treated as a duplicate submission.
Many payers require modifier 76 (or 77 for different physician) to process a same-day duplicate procedure claim. Without it, the second claim is denied as a duplicate.
Modifier 77 is used when a repeat procedure is performed by a different physician. Use 76 when the same physician repeats the service.
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