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CMS/Novitas 76 modifier

STACY Posted Wed 07th of March, 2018 11:30:45 AM
Let's say a patients dosage is 18gm of Carimune (J1566). To make up that dosage one 12gm vial(NDC#44206-0418-12) is mixed with a 6gm vial (NDC#44206-0417-06) to make up the 18gm prescribed dose. I am trying to get clarification on appropriate billing. Is it appropriate to bill exactly what was dispensed (the two seperate NDC's on seperate line items) and add the 76 modifier to one of the line items OR is it appropriate to combine both vials into one line item of the same drug with no modifier? My concern with billing it combined on one line item we would not be billing exactly what was dispensed. I am billing this to Novitas/CMS for payment with a covered diagnosis of G70.01.
SuperCoder Answered Thu 08th of March, 2018 08:28:26 AM



It is appropriate to bill two seperate NDC's on seperate line items and 76 modifier is not required. 76 modifier is used for repeat procedure or service by same physician or other qualified health care professional.

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