Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Modifiers)
MOD Description Submission Guidelines Impact to Payment
-66 Surgical Team The use of this modifier is appropriate to
identify the services of a physician
involved as part of a surgical team. Under
some circumstances, highly complex
procedures (requiring the concomitant
services of several physicians, often of
different specialties) are carried out under
the “surgical team” concept.
-73 Discontinued
out-patient
hospital/
ambulatory
surgery center
(ASC) procedure
prior to the
administration of
anesthesia
-76 Repeat
Procedure or
Service by Same
Physician
11-10
Due to extenuating circumstances or those
that threaten the well being of the patient,
the physician may cancel a surgical or
diagnostic procedure subsequent to the
patient's surgical preparation, but prior to
the administration of anesthesia. Under
these circumstances, the intended service
that is prepared for but cancelled can be
reported by its usual procedure number and
the addition of the modifier -73.
The practitioner may need to indicate that a
procedure or service was repeated
subsequent to the original procedure or
service on the same day. This circumstance
may be reported by adding modifier –76 to
the repeated procedure/service.
Note: In situations warranting the use of
both the –26 and –76 modifier (e.g.,
reading multiple chest X-rays of a patient
performed on the same day), submit the –
26 modifier in the first position with the
initial procedure and the –76 in the first
position for the repeat procedure.
Payment will be
determined based on a
case-by-case basis
and review of
supporting
documentation.
Payment is made at
50% of the allowed
amount.
Effective for claims
processed on and after
January 1, 2012.
Separate payment of
the service may be
made.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (10/05/11)