I work at an Internists' office. We provide services almost on a daily basis (sometimes twice daily) for one of our pts with a very rare case of herpes zoster. For this pts typical visit we bill: 99214, 64400(x6), 64405(x2), 20553, J2001(x5) and S0020 (x5). She has on a few occasions come in twice on the same day for the above. When this happens I attach modifier 25 to the E/M and mod. 76 to the procedure codes. Excellus has denied this in the past "insufficient modifier", so I have tried without and they all come back denied because I have exceeded the # of units on the 64400 (since the claims are combined whe you have ECS). Am I correct with the modifiers?? Is there something that I should be doing differently?? Any help would be greatly apprectiated. Thanks!