CurrentAnthemPolicy C-21006

Modifier 66 - Professional, Commercial Reimbursement Policy

Defines Anthem's reimbursement stance and billing rules for procedures billed with modifier 66 (surgical teams) for commercial lines; applies to professional providers submitting claims to the health plan.

Policy Summary

PayerAnthem

PolicyModifier 66 - Professional, Commercial Reimbursement Policy

Policy CodePolicy C-21006

Change TypeClarification and title revision (non‑material)

Effective DateNov 17, 2023

Next Review DateN/A

Key ActionBill each physician's individual procedure codes with modifier 66 to avoid denials or pends; follow authorization and medical necessity requirements.

SourceLink

POLICY UPDATE CHANGES

Clarifying language was added to indicators.

Policy title was changed by removing 'Team Surgeon Services'.

12/02/2025 review approved with no changes.

MPFS 1 & 2codes reimbursable with modifier 66

MPFS 0 & 9codes non-reimbursable with modifier 66

1CMS MPFS referenced

C-21006policy id

Reimbursement Criteria

Reimbursement criteria for Modifier 66

Reimbursement is permitted only for procedures identified by CMS MPFS Team Surgery payment indicators 1 and 2 when billed with modifier 66; indicators 0 and 9 are not reimbursable.

Procedure must have MPFS Team Surgery payment indicator 1 or 2 to be reimbursable when billed with modifier 66.

Procedures with MPFS Team Surgery payment indicator 0 or 9 are not reimbursable with modifier 66.

Each physician participating in the surgical team must bill the applicable procedure code(s) for their individual services with modifier 66.

Failure to apply modifier 66 appropriately may result in claims being denied or pended for duplicate or suspected duplicate services.

Assistant/multiple procedure guidance

Assistant surgeon rules and/or fee reductions apply if a member of the surgical team acts as an assistant in performing additional procedure(s) during the same surgical session.

Policy Summary

PayerAnthem

PolicyModifier 66 - Professional, Commercial Reimbursement Policy

Policy CodePolicy C-21006

Change TypeClarification and title revision (non‑material)

Effective DateNov 17, 2023

Next Review DateN/A

Key ActionBill each physician's individual procedure codes with modifier 66 to avoid denials or pends; follow authorization and medical necessity requirements.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Note: Assistant surgeon rules do not apply to procedures appropriately billed with modifier 66.

Multiple procedure rules apply when multiple procedures are performed by the surgical team, except multiple procedure rules do not apply when surgeons of different specialties each perform a different procedure.

Standard correct coding and CMS MPFS indicator mapping apply as the source for determining eligibility.

MPFS Indicators and Modifier Usage

MPFS Team Surgery payment indicators - ReimbursablemixedCovered

MPFS Team Surgery indicator 1	Reimbursable when billed with modifier 66
MPFS Team Surgery indicator 2	Reimbursable when billed with modifier 66

MPFS Team Surgery payment indicators - Not ReimbursablemixedNot Covered

MPFS Team Surgery indicator 0	Not reimbursable with modifier 66
MPFS Team Surgery indicator 9	Not reimbursable with modifier 66

Modifier usage requirement (inv-03)

RequirementEach physician participating in the surgical team must bill the applicable procedure code(s) for their individual services with modifier 66.

Consequence of omissionIf any or all physicians fail to use modifier 66 appropriately, claims may be denied or pended for duplicate or suspected duplicate services.

ApplicabilityApplies when procedures are eligible for surgical teams as identified by CMS MPFS Team Surgery payment indicators, unless provider, state, or federal contracts or requirements indicate otherwise.

Billing and Authorization Expectations

Billing Rule

Bill each surgeon's procedure with modifier 66 or risk denial/pend

Bill each physician's individual procedure codes with modifier 66 for surgical team services; failure to apply the modifier appropriately may result in claims being denied or pended for duplicate or suspected duplicate services. Follow authorization and medical necessity requirements in addition to correct coding and submission guidelines.

Each physician participating in the surgical team must bill their applicable procedure code(s) with modifier 66.
If physicians fail to use modifier 66 appropriately, claims may be denied or pended for duplicate or suspected duplicate services.
Services must meet authorization and medical necessity guidelines and be supported by proper documentation and industry-standard codes.

Terminology

Modifier 66 definition (inv-05)

DefinitionModifier 66 (Surgical Team): Used for highly complex procedures requiring the concomitant services of several physicians or other qualified health care professionals, often of different specialties, plus other highly skilled, specially trained personnel and complex equipment, carried out under the surgical team concept.

ContextModifier 66 is added to the basic procedure number to report services provided under the surgical team concept.

Typical circumstancesUsed when multiple specialists and specialized personnel are required to perform a single highly complex procedure.

Document History

2025-12-02reviewLatest

Review approved with no changes.

2023-11-17revision

Policy title revised (removed 'Team Surgeon Services') and clarifying language added to MPFS team surgery indicators; review approved and effective.

2021-09-24initial_approval

Initial policy approved; Co-Surgeon/Team Surgeon Services policy (C-08001) retired and split into new policies including Modifier 66: Surgical Teams (C-21006) effective 2022-11-01.