CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPOOg

Co-Surgeon/Team Surgeon Policy - Professional Provider

Defines coding and reimbursement requirements for professional provider claims when two or more surgeons or qualified health professionals perform the same operation (co-surgeon or team surgeon). Applies to professional (non-UB-04) billing and affects participating providers submitting CPT-coded claims.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyCo-Surgeon/Team Surgeon Policy - Professional Provider

Policy CodePolicy CPCPOOg

Change TypeAnnual reviewminor edits

Effective DateApr 18, 2025

Next Review Date

Key ActionSubmit accurate documentation and provide supporting records promptly if requested by the plan.

SourceLink

POLICY UPDATE CHANGES

Annual review; Grammatical updates; Updated References.

2surgeons required for modifier 62

more than 2surgeons for team surgery (modifier 66)

62, 66applicable primary modifiers discussed

NPFS 1 or 2CMS eligibility requirement referenced

Reimbursement Eligibility

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Co-surgeon and team surgeon reimbursement criteria

Covered when ALL of the following are met:

CPT/HCPCS code must have NPFS co-surgery/team-surgery status indicator of '1' or '2' to be eligible.

Services rendered by the surgeons or surgical team are determined to be medically necessary.

Co-surgery (Modifier 62)

Two surgeons with different specialties performing the procedure or two surgeons performing the procedure simultaneously.
Each co-surgeon submits the same appropriate surgical CPT code with modifier 62 in the first position.
Each co-surgeon provides a separate operative report documenting their distinct role in the procedure.

Team surgery (Modifier 66)

A team composed of more than two surgeons of different specialties is required to perform the highly complex procedure.
Each team surgeon submits the same appropriate surgical CPT code with modifier 66 in the first position.
Supporting documentation describing each team member's individual contribution is supplied.

Physicians who function as assistants (not co-surgeons) should not append modifier 62; assistant services should be billed with the appropriate assistant modifiers and/or codes.

The plan reserves the right to request supporting documentation; failure to provide requested documentation or to adhere to coding and billing policies may affect reimbursement.

Modifiers and Code Eligibility

Modifiers for multi-surgeon servicesModifierCovered

62	Two surgeons acting as co-surgeons; append modifier 62 in the primary modifier position; both surgeons should submit the same CPT and diagnosis and separate operative reports describing each surgeon's services.
66	Team surgeon; more than two surgeons of different specialties working together under the surgical team concept; append modifier 66 in the primary modifier position; submit supporting documentation/operative reports describing each surgeon's performance.

Modifiers for multi-surgeon services (alternate system listing)Modifier | CPTCovered

Modifier 62	Two surgeons acting as co-surgeons; append in primary modifier position; both surgeons submit same CPT and diagnosis; separate operative reports required.
Modifier 66	Team surgeon; more than two surgeons of different specialties; append in primary modifier position; supporting documentation describing each surgeon's role required.

CMS NPFS status indicator requirement

Eligibility requirementOnly CPT/HCPCS codes listed in the CMS National Physician Fee Schedule (NPFS) with a co-surgery/team-surgery status indicator of '1' or '2' are eligible for co-surgeon or team-surgeon reimbursement.

Modifier applicationEligible procedures must be billed with the appropriate modifier in the first (primary) modifier position (modifier 62 for co-surgeon; modifier 66 for team surgeon).

Medical necessityServices rendered by both the co-surgeons or by the surgical team must be determined to be medically necessary for reimbursement eligibility.

Same CPT code requirementEach participating surgeon/team member must submit the same appropriate surgical CPT code on their individual claim(s).

Documentation implicationClaims must support the NPFS indicator eligibility and medical necessity; the plan may request supporting documentation to validate reimbursement eligibility.

Documentation and Claim Review

Documentation Required

Documentation request — submit supporting records

Providers are responsible for submitting accurate documentation for services performed. The plan may request supporting documentation to validate services billed; providers should submit additional documentation upon request to avoid delays or denials.

Submit documentation when requested to support medical necessity, coding, or bundling decisions.
Include all relevant medical records, operative notes, imaging, test results, and other source documents.
Respond promptly to requests to prevent claim processing or reimbursement delays.

Billing Rule

Claim review and coding accuracy — claims are subject to review

Claims are subject to review for coverage, contract terms, medical and coding policies, and coding software logic. Providers must submit claims using valid codes from HIPAA-approved code sets and follow industry coding guidelines. Failure to adhere to coding and billing policies may affect claim processing and reimbursement.

Use appropriate code sets: CPT, HCPCS, ICD-10-CM/PCS, NDC, DRG, and applicable modifiers.
Follow coding resources and edits: AMA CPT guidance, CMS NCCI edits, CCI tables, UB conventions, and payer-specific coding rules.
Be prepared for claim-level review including benefit terms, provider contract language, medical policies, clinical payment policies, and coding software logic.
Provide additional documentation when requested to substantiate billed codes and services.

Key Definitions

Co-Surgeon Services definition

Definition (Co-Surgeon Services)Two surgeons with different individual skills working together as primary surgeons to perform distinct parts of the same surgical procedure on the same patient during the same operation; billed with modifier 62.

Distinct rolesEach co-surgeon performs a unique portion of the operation and must document their individual contributions in separate operative reports.

Billing expectationsBoth co-surgeons should bill the same procedure code with modifier 62 appended in the primary modifier position; physicians cannot bill as assistants for the procedure in which they acted as co-surgeons.

Team Surgeon Services definition

Definition (Team Surgeon Services)Team surgery occurs when more than two physicians, usually of different specialties, and/or other qualified health professionals are required to perform highly complicated procedures on the same patient; identified by appending modifier 66.

Team compositionTeams must be composed of more than two surgeons of different specialties; may include assistant surgeons, nurse practitioners, and physician assistants as appropriate.

Billing expectationsTeam surgery services must be submitted with the appropriate surgical CPT code and modifier 66 listed in the first (primary) modifier position; documentation describing each team member's role is required.