Modifiers · CPT modifier

Repeat procedure same physician

Modifier 76 tells a payer that the same physician intentionally repeated an identical procedure on the same patient during the same date of service — not by accident, not by a different provider. It separates a legitimate, medically necessary repeat service from what would otherwise look like a duplicate billing error, and it applies only to procedures that cannot be quantity-billed on a single line.

Verified May 8, 2026 · 8 sources ↓

Type: CPT
CPT codes use it: 893
Top regions: Foot & ankle, Other, Hand

Drawn from AMACMSNovitasBcbsndPremera

When to use modifier 76

Source · Editorial brief grounded in 8 cited references ↓

Append modifier 76 when three conditions align simultaneously: the procedure code is identical to one already billed that day, the performing provider is the same physician or qualified healthcare professional, and a distinct clinical event — not a technical redo — drove the decision to repeat. Classic triggers include an acute change in patient status between services, post-intervention monitoring requiring a fresh baseline measurement, or an unexpected intraoperative finding that forces a second discrete procedure during the same operative session.

On the claim form, bill the first occurrence of the code without any modifier at one unit. Place the identical code on a second line, append modifier 76, and enter the number of additional repetitions as the unit count on that line. Critically, document the clock time of each service in Item 19 of the CMS-1500 or the EDI 2300 NTE segment. Payers — including Medicare contractors — use those timestamps to confirm the services were separate events rather than a data entry error. Skipping the time notation is one of the fastest routes to an automatic denial.

Modifier 76 is valid on surgical and diagnostic codes but is explicitly excluded from Evaluation and Management services, most laboratory codes, and pathology codes. When a different provider — not the original physician — performs the repeat, substitute modifier 77. When a repeat laboratory test is run on the same specimen to generate serial result values, use modifier 91 instead. Knowing these boundaries keeps the right modifier on the right line and prevents avoidable payer audits.

Orthopedic scenarios

Concrete situations in orthopedic practice that warrant modifier 76.

Source · Editorial brief grounded in AAOS coding guidance and cited references ↓

A patient undergoes ORIF of a distal radius fracture (CPT 25607) and intraoperative fluoroscopy shows acceptable reduction. Post-cast application, the surgeon orders a fresh wrist X-ray series (CPT 73100) to confirm maintained alignment; bill the post-cast series as 73100-76 with the pre- and post-cast times documented in Item 19.
During an arthroscopic knee procedure, the surgeon performs a partial medial meniscectomy (CPT 29881). An unexpected lateral meniscus tear identified at the same session requires a separate arthroscopic partial lateral meniscectomy — if the code maps to the same CPT, append modifier 76 to the second line with operative note timestamps supporting two discrete operative events.
A total knee arthroplasty patient develops acute hemodynamic changes in the recovery room; the attending orthopedic surgeon orders an ECG (CPT 93000) at 09:15 and a second ECG at 11:40 to evaluate interval changes. Bill the second ECG as 93000-76 with both times in the narrative field.
An orthopedic trauma patient receives an AP pelvis X-ray (CPT 72170) on admission and, after closed reduction of a hip dislocation, a second AP pelvis X-ray is taken by the same radiologist to confirm relocation. Report the post-reduction film as 72170-76, documenting pre- and post-reduction acquisition times.
Following a shoulder arthroplasty, an intraoperative fluoroscopic image (CPT 76000) is obtained at component placement and again after trial reduction to assess offset and version. If the same surgeon captures and interprets both images, the second is reported as 76000-76 with separate timestamps in the operative record.

Common mistakes

Where coders most often go wrong with modifier 76.

Source · Editorial brief grounded in CMS NCCI Policy Manual and cited references ↓

Appending modifier 76 to an E/M code (e.g., 99213): payers universally reject this combination; use modifier 25 or 27 for same-day E/M scenarios instead.
Forgetting to record the clock time of each service in Item 19 or the EDI equivalent — Medicare contractors treat the missing timestamp as evidence of duplicate billing and deny the repeat line automatically.
Using modifier 76 when a different physician performed the repeat procedure; that scenario requires modifier 77, and swapping them triggers a provider-identity mismatch on the claim.
Billing both lines at 1 unit each when two repeats occurred: the correct approach is to put the total count of additional repetitions (e.g., 2 units) on the modifier 76 line rather than opening a third separate claim line.
Applying modifier 76 to laboratory or pathology codes: most payers, including Premera and Wellpoint, explicitly deny modifier 76 on lab/path services and require modifier 91 for serial lab testing instead.
Assuming modifier 76 covers a redo prompted by technical failure or poor imaging quality — that scenario does not constitute a new medically necessary service and should not be billed as a repeat under modifier 76.
Exceeding the payer's Medically Unlikely Edit (MUE) limit without stacking modifier 76 correctly; for example, CPT 71045 carries an MUE of 4, so billing five chest X-rays on the same day will hard-deny regardless of modifier use.

CPT codes that use modifier 76

893 orthopedic CPT codes in our reference list this modifier as applicable. Sorted by total RVU.

Source · Derived from per-code modifier guidance in our CPT reference

Showing top 12 of 893 by total RVU.

Where modifier 76 shows up

Body regions where this modifier most commonly appears in our orthopedic reference.

Foot & ankle 173 codes
Other 124 codes
Hand 98 codes
Knee 88 codes

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can modifier 76 be used more than once on the same claim for the same CPT code?

Yes — but only one modifier 76 line is needed. Bill the first occurrence without a modifier, then place all additional repetitions as a unit count on a single modifier 76 line rather than opening multiple 76 lines. For example, four identical chest X-rays by the same physician are submitted as one line at 1 unit (no modifier) and one line at 3 units with modifier 76, provided the total does not exceed the payer's MUE for that code.

02What documentation must accompany a modifier 76 claim to survive a payer audit?

At minimum, the medical record must establish a separate clinical justification for the repeat — not just 'repeat ordered' — along with the clock time of each service, the name of the performing provider, and a clear link between the patient's interval change in condition and the decision to repeat the procedure. Wellpoint and other commercial payers have stated they will deny modifier 76 claims outright if supporting documentation is not submitted with the claim.

03Is modifier 76 appropriate when a procedure is repeated because of poor image quality or equipment malfunction?

No. A redo driven by technical failure — bad scout image, motion artifact, equipment reset — does not represent a new medically necessary service and should not be billed with modifier 76. Billing a technically failed repeat as if it were a clinically indicated second procedure is a compliance risk and can constitute improper billing.

04What is the difference between modifier 76 and modifier 77?

Modifier 76 applies when the same provider who performed the initial procedure also performs the repeat. Modifier 77 applies when a different physician or qualified healthcare professional repeats the procedure on the same date. Using 76 when the provider changed — or 77 when the provider did not — creates a provider-identity mismatch that results in denial or post-payment recoupment.

05Why can't modifier 76 be appended to E/M codes?

E/M services are inherently non-identical across encounters because each visit is defined by the unique clinical decision-making and history elements documented at that specific time; no two E/M visits are truly the same procedure. Both CMS guidance and major commercial payer policies — including BCBS of North Dakota — explicitly prohibit modifier 76 on E/M codes and direct billers to use modifiers 25 or 27 for same-day E/M situations instead.

06Does modifier 76 apply within the global surgical period as well as on the date of surgery?

Yes. Several payer policies, including Premera Blue Cross, recognize modifier 76 when the same procedure is repeated within the post-operative global period — not only on the surgical date. The same documentation standards apply: record the dates of both services, confirm same-provider identity, and document the clinical rationale that distinguishes the repeated service from routine post-operative care already bundled into the global package.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

01AMA CPT Professional Edition — Appendix A, Modifier 76 descriptor and guidelines
02CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 20.6.5
03
novitas-solutions.com
https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00092327
04
bcbsnd.com
https://www.bcbsnd.com/providers/policies-precertification/reimbursement-policy/modifiers-76-77-and-91-repeat-and-duplicate-services
05
premera.com
https://www.premera.com/portals/provider/paymentpolicies/CMI_051726.pdf
06
provider.wellpoint.com
https://www.provider.wellpoint.com/docs/gpp/WA_WLP_RP_Modifier76.pdf
07
findacode.com
https://www.findacode.com/articles/reporting-modifiers-76-77-confidence-37363.html
08
aapc.com
https://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/modifier-of-the-month-use-76-when-one-physician-repeats-procedurex-ray-study-article

Mira AI Scribe

When your AI scribe or ambient documentation tool captures a same-day repeat procedure, it must flag three data points to support modifier 76: (1) confirmation that the performing provider is identical for both services, (2) a distinct clinical reason — separate from the original indication — that drove the repeat, and (3) the exact clock time of each service. Without all three, the modifier 76 claim line will likely deny on first submission. Configure your scribe to auto-populate Item 19 of the CMS-1500 with formatted service times (e.g., '09:15 a.m. / 11:40 a.m.') and to flag any note that lacks an explicit rationale for repeating the procedure. A well-structured operative or progress note that answers 'why again, why now, and who did it' is the single strongest defense against a payer audit of modifier 76 claims.

See how Mira flags modifier 76 in dictation