CurrentBlue Cross Blue Shield - MainePolicy C-21006

Modifier 66 (Surgical Team) reimbursement

This commercial reimbursement policy governs when the health plan allows payment for procedures billed with modifier 66 for surgical teams, using CMS MPFS Team Surgery payment indicators to determine eligibility. It applies to professional providers submitting claims to Blue Cross Blue Shield - Maine under the commercial reimbursement framework.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyModifier 66 (Surgical Team) reimbursement

Policy CodePolicy C-21006

Change TypeAdministrative reviewclarified/revised language

Effective DateNov 17, 2023

Next Review DateN/A

Key ActionProviders must bill applicable procedure codes with modifier 66 for each participating physician to avoid denials or pended claims.

SourceLink

POLICY UPDATE CHANGES

Review approved: no changes.

Removed 'Team Surgeon Services' from policy title and added clarifying language to indicators.

MPFS 1 & 2Codes eligible for reimbursement

MPFS 0 & 9Codes not reimbursable

NoneExemptions

CMS MPFSEligibility source

Coverage Criteria for Modifier 66

Coverage criteria for Modifier 66

Reimbursement eligibility is determined by CMS MPFS Team Surgery payment indicators and correct use of modifier 66 by each participating surgeon.

Reimbursement is allowed for procedures eligible for surgical teams when billed with modifier 66, unless provider, state, or federal contracts or requirements indicate otherwise.

Reimbursable codes

Codes identified with MPFS Team Surgery payment indicator '1' are reimbursable when billed with modifier 66.
Codes identified with MPFS Team Surgery payment indicator '2' are reimbursable when billed with modifier 66.

Non-reimbursable codes

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyModifier 66 (Surgical Team) reimbursement

Policy CodePolicy C-21006

Change TypeAdministrative reviewclarified/revised language

Effective DateNov 17, 2023

Next Review DateN/A

Key ActionProviders must bill applicable procedure codes with modifier 66 for each participating physician to avoid denials or pended claims.

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.

Coding and Payment Indicators

Team surgery payment indicators - EligiblemixedCovered

MPFS indicator 1	Eligible for reimbursement with modifier 66
MPFS indicator 2	Eligible for reimbursement with modifier 66

Team surgery payment indicators - Not reimbursablemixedNot Covered

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

Modifier usage requirement

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

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

ApplicabilityApplies to all physicians participating in the surgical team for procedures identified as team-eligible under CMS MPFS indicators.

Definitions

Modifier 66

DefinitionModifier 66 denotes surgical team services where highly complex procedures require the concomitant services of several physicians or other qualified health care professionals, often of different specialties, plus other specialized personnel.

When to useUse modifier 66 when reporting the basic procedure number for an individual participating team member in circumstances meeting the surgical team concept.

Relation to reimbursementProcedures identified as team-eligible under CMS MPFS Team Surgery payment indicators are reimbursable when billed with modifier 66 per policy criteria.

Coding supportStandard correct coding and documentation must support use of modifier 66; failure to apply modifier may lead to denials or pended claims.

OpenPayer

Modifier 66 (Surgical Team) reimbursement

Coverage Criteria for Modifier 66

Coding and Payment Indicators

Billing and Claim Submission Requirements

Definitions