- Anesthesia Modifiers
- Appropriate Usage of Modifier 99
- Assistants at Surgery at Teaching Hospitals
- Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission
- Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, T1-T9 and TA vs. Modifier 50
- Correct Usage of Modifier 79 for Multiple Procedures
- Co-Surgery/Team Surgery/Assistant Surgery Modifiers
- Modifier 25
- Modifier 33
- Modifier 51
- Modifier 52 Claim Submission Billing Reminder
- Modifier 59 and the Subset Modifiers XE, XP, XS, XU - Specific Modifiers for Distinct Procedural Services
- Modifier 90 Reference to Outside Laboratory
- Modifiers
- Modifier Usage
- Proper Billing of Surgical Comanagement (Modifiers 54 and 55)
- Proper Use of Modifiers 59 and 91
- Reminder for Submission of Modifier 22
- Repeat Procedures - Modifiers 76 and 77
Co-Surgery/Team Surgery/Assistant Surgery Modifiers
Table of Contents
- Co-Surgery/Team Surgery/Assistant Surgery Modifiers
- Co-Surgery (Modifier 62)
- Team Surgery (Modifier 66)
- Assistant-at-Surgery Services
- Related Content
Co-Surgery/Team Surgery/Assistant Surgery Modifiers
We have identified significant payment errors in regard to co-surgery, team surgery and assistant surgery. These errors occur because the appropriate modifier was not applied correctly.
Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedures and/or the patient’s condition. In these cases, the additional physicians are not acting as assistants at surgery, but could be acting as co-surgeons or team surgeons depending on the situation.
If you participate in a surgical procedure as an assistant surgeon, co-surgeon or team surgeon, you must add the appropriate modifier to the surgical procedure(s). Pay special attention to the descriptions of the modifiers in this article to ensure you are submitting the one appropriate for your service.
Different procedures require no modifier – If surgeons of different specialties are each performing a different procedure (with different CPT codes), neither co-surgery nor multiple surgery rules apply (even if the procedures are performed through the same incision). If one of the surgeons performs multiple procedures, the multiple procedure rules apply to that surgeon’s services.
The following billing procedures apply when billing for a surgical procedure or procedures that require the use of two surgeons or a team of surgeons.
Co-Surgery (Modifier 62)
If two surgeons (each in a different specialty) are required to perform a specific task associated with the same surgical procedure, each surgeon bills for the procedure with a modifier 62 (two surgeons). Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously, i.e., heart transplant or bi-lateral knee replacement.
Note: If one provider bills for modifier 62 and another provider billing the same service on the same date of service did not utilize the 62 modifier, the claim may be denied. If one/both of the claims were paid incorrectly, recoupments/overpayments may be requested.
The following indicators on the MPFSDB pertaining to co-surgery; help you determine if Medicare allows co-surgeons to be paid, may allow co-surgeons to be paid with documentation or never pays for co-surgeons for a specific procedure.
Co-surgeons (working together as primary surgeons):
- “2” Indicator = Co-surgeons permitted. No documentation is required if the two specialty requirements are met. (Both surgeons add CPT modifier 62 to the surgical procedure)
- “1” Indicator = Co-surgeons could be paid. Supporting documentation is required to establish medical necessity of two surgeons for this procedure.
- “0” indicator = Co-surgeons not permitted for this procedure.
With regard to payment, for co-surgeons (modifier 62), the fee schedule amount related to the payment for each co-surgeon is 62.5 percent of the global surgery fee schedule amount.
Team Surgery (Modifier 66)
If a team of surgeons (more than two surgeons of the same or different specialties) is required to perform a specific task associated with the same surgical procedure, each surgeon bills for the procedure with a modifier 66 (surgical team).
The following indicators on the MPFSDB pertaining to team surgery will help you determine if Medicare allows team surgeons to be paid, may allow team surgeons to be paid with documentation or never pays for team surgeons for a specific procedure.
To establish a team of surgeons was medically necessary, all claims for team surgeons must contain sufficient information to allow pricing ‘by report’.
Team surgeons (performing highly complex procedures; often requiring different physician specialties):
- “2” Indicator = Team surgeons permitted; pay by report.
- “1” Indicator = Team surgeons could be paid. Supporting documentation is required to establish medical necessity of a team; paid by report.
- “0” Indicator = Team surgeons not permitted for this procedure.
With regard to payment, for team surgeons (modifier 66), payment is made on a “by report” basis.
Assistant-at-Surgery Services
For assistant-at-surgery services performed by physicians, the fee schedule amount equals 16 percent of the amount otherwise applicable for the surgical payment. A/B MACs may not pay assistants-at-surgery for surgical procedures in which a physician is used as an assistant at surgery in fewer than five percent of the cases for that procedure nationally. This is determined through manual reviews.
Assistant Surgery Modifiers
Procedures billed with the assistant surgery physician modifiers 80 (assistant surgeon), 81 (minimum assistant surgeon), 82 (assistant surgeon when a qualified resident surgeon was not available), indicate that a physician served as the assistant at surgery.
For nonphysician practitioners (physician assistants, nurse practitioners and clinical nurse specialists), modifier AS is used to indicate they are billing as the assistant at surgery. Medicare pays claims for procedures with these modifiers only if the services of an assistant at surgery are authorized.
Medicare’s policies on billing patients in excess of the Medicare-allowed amount apply to assistant at surgery services. Physicians who knowingly and willfully violate this prohibition and bill a beneficiary for an assistant at surgery service for these procedures may be subject to the penalties contained under Section 1842(j)(2) of the Social Security Act. Penalties vary based on the frequency and seriousness of the violation.
The following indicators on the MPFSDB pertaining to assistant at surgery help you determine if Medicare allows assistants at surgery to be paid, may allow assistants at surgery to be paid with documentation or never pays for assistants at surgery for a specific procedure.
- “2” Indicator = Payment restriction for assistants at surgery does not apply to this procedure. Assistants at surgery may be paid.
- “1” Indicator = Statutory payment restriction for assistants at surgery applies to this procedure. Assistants at surgery may not be paid.
- “0” Indicator = Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
Related Content
- Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 100.2
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Sections 20.4.3, 40.8, 100.1.7 and 110.
- Fee Schedule Lookup Tool
Reviewed 10/2/2024