Identification of Repeat Services for FEP
Issue: #398 DEC2017
When procedures such as X-rays, lab tests or various therapies have been repeated, it is important to utilize modifiers to indicate that the service was repeated. Surgical procedures may also be repeated, or the same procedure may be performed bilaterally. If the correct modifiers are not used, these services may be denied as a duplicate charge. The units field may also be utilized to indicate multiple services where appropriate.
Modifiers that indicate repeat, multiple or bilateral services are:
- 50 – Bilateral procedure
- 51 – Multiple procedures
- 59 – Distinct procedural service
- 76 – Repeat procedure by same physician
- 77 – Repeat procedure by another physician
- 91 – Repeat clinical diagnostic laboratory test
Note: While this information applies to all contracts, it is especially important for FEP, as they will be following this duplicate service guideline and will deny any duplicate service submitted without the appropriate modifier where applicable.