In a recent release of 2018 benchmarks regarding modifiers 76, 77 and 79, the data of payment vs denials is staggering. For instance, a total of 159 codes reported with 91 and 249 codes that were reported using modifier 77 all had a 100% denial rate. Compared to the 952 codes that were denied when reported with 76 that doesn’t seem so bad. But considering your bottom line and the time it takes your team to resubmit it adds up to money lost.

However when we step back and look at the big picture we see that modifier 76 although the most reported, still had the lowest overall denial rate at just 5%.

Modifier Times Reported Percentage Denied Total Denied Total Paid
76 119,200,000 5% 5,960,000 113,240,000
77 706,223 14% 98,871 607,352
91 3,000,000 20% 600,000 2,400,000


Watching your reporting trends and utilizing billing reports will help make sure you avoid costly denials. Be aware of National Baselines for your specialty and where you fall within them.