Key Points/Instruction/What you need to know
Modifier 77 is used to report a repeat procedure by another physician and is appended to the repeat procedure to:
• Report the same service provided by another physician.
• Indicate that a basic procedure or service had to be repeated.
Appropriate Uses:
• Adding modifier 77 to the professional component of an X-Ray or Electrocardiogram (EKG) procedure when the patient has two or more tests and more than one physician provides the interpretation and report.
o CMS will reimburse a second interpretation of the same EKG or X-ray only under unusual circumstances, such as:
• A questionable finding for which the physician performing the initial interpretation believes another physician’s expertise is needed, or
• A change in diagnosis resulting from a second interpretation
Note: Absent these circumstances, Novitas Solutions may reimburse only the interpretation and report that directly contributed to the diagnosis and treatment of the individual patient.
Inappropriate Uses:
• Billing for multiple services which are considered bundled.
• Appending Modifier 77 to an Evaluation and Management Code.
Claim Submission Instructions
Report each procedure on separate lines.
List the procedure code once by itself and then again with modifier 77.
Do not use the units’ field to indicate the procedure was performed more than once on the same day.
Add modifier 77 when billing for multiple services on a single day and the service cannot be quantity billed.
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