CurrentBlue Cross Blue Shield - OklahomaPolicy CPCP009

Co-Surgeon/Team Surgeon Modifiers

Defines coding and reimbursement rules for use of co-surgeon (modifier 62) and team surgeon (modifier 66) billing for surgical procedures for providers submitting CMS 1500 claims to BCBSOK; applies to all products and both in-network and out-of-network physicians and qualified health care professionals.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyCo-Surgeon/Team Surgeon Modifiers

Policy CodePolicy CPCP009

Change TypeNo material changes

Effective DateSep 16, 2020

Next Review DateN/A

Key ActionAppend modifier 62 for co-surgeon services or modifier 66 for team surgery in the primary modifier position and submit claims on CMS 1500 with operative reports as requested.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

modifier 62required modifier for co-surgeon billing

modifier 66required modifier for team surgery billing

NPFS status 1 or 2eligible CPT/HCPCS codes

CMS 1500claim form required

in & out of networkapplies to

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Reimbursement Criteria for Co-Surgeon and Team Surgeon Billing

Reimbursement criteria

Claims for co-surgery or team surgery are eligible for reimbursement only when the following criteria are met:

Appropriate modifier appended in first (primary) position: modifier 62 for co-surgery, modifier 66 for team surgery.

Procedure CPT/HCPCS code appears in the CMS National Physician Fee Schedule (NPFS) with a co-surgery or team-surgery relative value file status indicator of '1' or '2'.

Services rendered must be medically necessary.

For co-surgery: two surgeons of different specialties performing the same procedure or two surgeons performing the procedure simultaneously with distinct portions; both surgeons must bill the same CPT code, append modifier 62 in the first position, and each must submit a separate operative report detailing their specific services.

Not co-surgery when

Two surgeons operate on completely different anatomic portions of the patient at the same date/time — these are not co-surgery and modifier 62 should not be applied.

Modifier 62 should not be billed when one surgeon is acting as an assistant; physicians cannot bill as assistants for procedures in which they acted as co-surgeons, though they may bill as assistants for a separate procedure during the same session if appropriately coded.

For team surgery: teams must be composed of more than two surgeons (usually of different specialties); each team surgeon must bill the same CPT code, append modifier 66 in the first position, and may be asked to submit operative reports describing each surgeon's services.

Co-surgeon and team surgery services must be billed on the CMS 1500 claim form; policy applies to all products and both in-network and out-of-network providers.

Multiple surgery reductions may apply.

If a conflict exists between this CPCP and a member's plan document or provider contract, the plan document or provider contract governs respectively. BCBSOK may request operative reports or other documentation and providers are urged to submit additional documentation upon request.

Eligible Procedure Codes and NPFS Status

Eligible procedure codesmixed

CPT/HCPCS with NPFS co-surgery status 1 or 2	Eligible for co-surgeon reimbursement when modifier 62 appended
CPT with NPFS team-surgery status 1 or 2	Eligible for team-surgery reimbursement when modifier 66 appended

NPFS status indicator requirement

NPFS status indicator requirementCodes must have NPFS co-surgery or team-surgery relative value file status indicator of '1' or '2' to be eligible for co-surgeon (modifier 62) or team-surgery (modifier 66) reimbursement.

Applicable code setsCPT/HCPCS codes listed in the National Physician Fee Schedule (NPFS) with status indicator '1' or '2'.

Modifier linkageIf NPFS status indicator is '1' or '2', append modifier 62 for co-surgery or modifier 66 for team surgery in the first (primary) modifier position.

Medical necessityEven when NPFS status indicator is '1' or '2', services must be medically necessary to be reimbursed.

Billing Modifiers and Documentation Requirements

Billing Rule

Append modifier 62 or 66 in primary position and provide operative reports on CMS 1500

Providers must append modifier 62 for co-surgeon services and modifier 66 for team surgery in the primary (first) modifier position. Claims should be submitted on the CMS 1500 form; each participating surgeon should use the same CPT code on their individual claim and may be asked to provide separate operative reports delineating the specific services each surgeon performed.

Append modifier 62 in the first modifier position when billing co-surgery; both surgeons must bill the same CPT code and submit separate operative reports describing each surgeon's work. [[Cited above]]
Append modifier 66 in the first modifier position when billing team surgery; each team surgeon must bill the same CPT code and may be asked to submit operative reports. [[Cited above]]
Submit claims on the CMS 1500 form and be prepared to provide operative reports or other documentation upon request. [[Cited above]]

Definitions

Co-Surgery (Co-Surgeon) definition

DefinitionCo-surgery: Situation in which two surgeons with different individual skills or specialties perform the same procedure during the same operation and same day, each performing a unique portion of the surgery; each should bill with modifier 62.

Billing requirementsEach co-surgeon must append modifier 62 and use the same CPT code on their claims; modifier 62 must be in the first modifier position.

DocumentationBoth surgeons must submit separate operative reports explicitly stating the services each performed during the surgery.

ExclusionIf two surgeons operate on completely different anatomic portions of the patient at the same date/time, it is not co-surgery and modifier 62 should not be applied.

Team Surgery definition

Definition