Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of surgeons from different specialties plus specially trained personnel and complex equipment — is required to perform the operation. Each participating surgeon appends modifier 66 to the primary CPT procedure code and must supply operative reports and documentation demonstrating the necessity of a team approach; two surgeons should instead use modifier 62.

Reimbursement practices vary by payer but share common principles: when modifier 66 is allowed the procedure payment is typically increased and then divided equally among the team surgeons, and assistant surgeon fees are not separately reimbursed. For example, Regence reimburses eligible procedures at 150% of the standard fee schedule and divides that amount equally among the team members, while historical North Carolina Medicaid guidance increased the fee schedule by 25% before splitting it. Medicare (Noridian) requires procedures eligible under MPFS indicators and often processes team-surgery claims “by report,” subject to medical review and manual pricing.

Use of modifier 66 requires clear, contemporaneous documentation from each surgeon showing why a multi-surgeon team was necessary (type of complexity, roles performed, and that three or more surgeons acted as primary surgeons). Claims lacking adequate supporting documentation are at risk for denial or manual review. Because payer rules and payment calculations differ, always verify the specific payer policy prior to billing or before scheduling a team-based operation.