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Thread: modifier 76 versus 59

  1. #1
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    Default modifier 76 versus 59

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    I am having an issue with an HMO insurance company. Example: For Medicare, if we are charging 88305 x 6, we would use modifier 76 on additional 88305's. However, the HMO has all the sudden decided we need modifier 59. Can anyone help me with documentation? I need some documentation that I can send to the HMO insurance company verifying that 76 is the correct modifier. Any help appreciated. Thanks Annette

  2. #2
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    Quote Originally Posted by annettebec View Post
    I am having an issue with an HMO insurance company. Example: For Medicare, if we are charging 88305 x 6, we would use modifier 76 on additional 88305's. However, the HMO has all the sudden decided we need modifier 59. Can anyone help me with documentation? I need some documentation that I can send to the HMO insurance company verifying that 76 is the correct modifier. Any help appreciated. Thanks Annette
    http://www.supercoder.com/articles/a...-of-modifiers/

    Medicare plays by their own rules...the 59 is technically correct for different specimens/sites.
    Last edited by btadlock1; 03-30-2011 at 01:55 PM.

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