The policy provides guidelines for the reimbursement of services with modifiers 76 and 77 for professional providers.
|76||Repeat procedure or service by same physician or other qualified health care professional|
|77||Repeat procedure by another physician or other qualified health care professional|
Use modifier 76 to indicate that a procedure or service was repeated subsequent to the original procedure or service by the same provider on the same patient on the same date of service or within the post-operative period.
Modifier 77 is reported when the same procedure or service has been performed by a different provider to the same patient on the same date of service or within the post-operative period of the original procedure.
Note: Do not append modifiers 76 or 77 to Evaluation and Management (E/M) services.
The sole fact that a procedure or service must be repeated after the original does not warrant additional payment above the allowance for the original procedure or service being reported.
While reimbursement is considered, payment determination is subject to, but not limited to:
In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.
|10/03/19||Added Limitations and Exclusions, Disclaimer and History.|
Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.