CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPOO9

Co-Surgeon/Team Surgeon Policy - Professional Provider

Defines coding, modifier use, and reimbursement criteria for co‑surgeon (modifier 62) and team surgeon (modifier 66) professional services billed to Blue Cross Blue Shield - Oklahoma; applies to providers submitting CMS-1500 claims for surgical services.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyCo-Surgeon/Team Surgeon Policy - Professional Provider

Policy CodePolicy CPCPOO9

Change TypeNo material changes

Effective DateSep 26, 2023

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide operative reports describing each surgeon's performance; claims are subject to claim review.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2modifier types specified (62, 66)

status 1 or 2NPFS eligibility requirement

CMS-1500Claim form required

Separate reportsDocumentation required

Reimbursement Eligibility Criteria

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Co-Surgery Reimbursement Criteria

Covered when ALL of the following are met:

ALL of the following

CPT/HCPCS code appears in the NPFS with a co-surgery status indicator of '1' or '2'
Services rendered by both surgeons are determined to be medically necessary
The procedure requires two surgeons with different specialties, or two surgeons performing the procedure simultaneously
Both surgeons submit the same appropriate surgical CPT code and each list modifier 62 in the first (primary) modifier position on their claim
Each surgeon submits a separate operative report that explicitly states what services each surgeon performed during the surgery
Physicians may not bill as assistants for procedures in which they acted as co-surgeons
Claims remain subject to claim review, benefit coverage, provider contract language, and coding software logic; additional documentation may be requested

Exclusions / Billing rules

Modifier 62 is not appropriate when surgeons operate on completely different anatomic portions during the same date/time (not co-surgery)
When one surgeon acted as an assistant rather than a co-surgeon, use appropriate assistant modifiers (e.g., 80 or 82) and billing conventions rather than modifier 62
Multiple surgery reductions may apply when a co-surgeon acts as an assistant for a separate procedure during the same session

Policy applies to services billed using the CMS-1500 claim form.

Team Surgery Reimbursement Criteria

Covered when ALL of the following are met:

ALL of the following

CPT code appears in the NPFS with a team surgery status indicator of '1' or '2'
Services rendered by the surgical team are determined to be medically necessary
The team is composed of more than two surgeons of different specialties
Each team surgeon submits the same appropriate surgical CPT code and lists modifier 66 in the first (primary) modifier position on their claim
Operative reports documenting each surgeon's role may be requested

Applicable Modifiers and Code Eligibility

Applicable ModifiersModifierCovered

62	Two surgeons — append when two surgeons with different specialties are required to perform a specific procedure on the same patient during an operative session, both acting as primary surgeons; both surgeons should append modifier 62 on the submitted claim; the procedure code and diagnosis code should be the same on the submitted claim.
66	Team surgeon — append when more than two surgeons of different specialties are working together under the surgical team concept; should be submitted with supporting documentation describing each surgeon's performance during the procedure; each team surgeon should submit modifier 66 on services where they are acting as primary surgeons.

NPFS status indicator requirement

NPFS status indicator requirementEligible CPT/HCPCS codes must appear in the National Physician Fee Schedule (NPFS) with a co-surgery or team surgery relative value file status indicator of '1' or '2'

Applies to co-surgeon reimbursement (modifier 62)HCPCS/CPT codes must have a co-surgery status indicator of '1' or '2' in NPFS to be eligible for co-surgeon reimbursement

Applies to team surgeon reimbursement (modifier 66)CPT codes must have a team surgery status indicator of '1' or '2' in NPFS to be eligible for team surgeon reimbursement

Documentation and Claim Review Requirements

Documentation Required

Documentation, Operative Reports, and Claim Review

Providers must submit accurate documentation of services performed and code claims using valid HIPAA-approved code sets; claims are subject to claim review and may require additional documentation upon request. Operative reports documenting each surgeon’s specific services must be submitted for co-surgery (modifier 62) and may be requested for team surgery (modifier 66); both surgeons should report the same CPT code with the appropriate modifier in the primary position. Failure to provide requested operative reports or to submit matching CPT codes with correct modifiers may result in claim review adjustments or denial under claim edit protocols and applicable provider contract/benefit terms.

Submit claims using valid HIPAA-approved code sets (CPT, HCPCS, ICD-10, etc.) and industry coding guidelines.
For co-surgery: each surgeon must append modifier 62 and submit a separate operative report explicitly stating the services each surgeon performed; both surgeons’ claims must list the same CPT code.
For team surgery: each team surgeon should append modifier 66 in the primary modifier position; operative reports may be requested to document each surgeon’s role.
Be prepared to provide additional documentation upon request; claims are subject to claim review, coding software logic, provider contract language, and benefit coverage terms.

Service Definitions

Co-Surgeon Services

DefinitionTwo surgeons with different individual skills perform parts of the same operation on the same day; each bills the procedure code with modifier 62 appended.

When to useUsed when two surgeons, often of different specialties, act as primary surgeons for unique portions of the same operation due to complexity or patient condition.

Billing noteBoth surgeons should submit the same surgical CPT code with modifier 62 in the first position.

Team Surgeon Services

DefinitionTeam surgery involves more than two physicians (and/or other QHPs) of different specialties performing highly complicated procedures on the same patient; identified by appending modifier 66.

Team compositionTypically more than two surgeons of different specialties and may include assistant surgeons, nurse practitioners, or physician assistants.

Billing noteEach team surgeon must submit the same surgical CPT code with modifier 66 listed in the first position.