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CPT Modifier 78

Provider Administrative Policy

Claims Submission
Policy Date
November 2007
Revised/June 2012
Provider Type(s)
All Providers  


Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.


CPT Modifier 78

CPT Modifier 78 is used with surgical procedures that require a return to the operating room within the post operative period of a previous, related procedure. The allowance for this type of service is 70 percent of the Blue Cross allowable or billed charges, whichever is less.  If multiple procedures are billed, refer to PAP257 for multiple procedure guidelines.

Policy History

Date Action Reason
June 2012 Revised Transparent language revision

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