CurrentColorado Rocky Mountain Health PlansPolicy 2026R9010A

Co-Surgeon and Team Surgeon reimbursement (CMS 1500)

Governs reimbursement rules for Co-Surgeon (modifier 62) and Team Surgeon (modifier 66) services billed on the CMS 1500 form for UnitedHealthcare Medicare Advantage plans and applies to network physicians and other qualified health care professionals.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCo-Surgeon and Team Surgeon reimbursement (CMS 1500)

Policy CodePolicy 2026R9010A

Change TypeNon-material updates to Resource, Policy, Definitions and Application history

Effective Dateas written

Next Review Date

Key ActionTeam Surgeons must submit written medical documentation describing each surgeon's involvement for reimbursement review.

SourceLink

POLICY UPDATE CHANGES

Resource section updated.

Policy, Definitions, and History sections updated on 9/5/2025.

Application section updated 6/1/2024.

63%reimbursement rate to each Co-Surgeon of the Allowable Amount

8modifier codes referenced

CMS 1500form applicability

1 or 2NPFS eligibility indicators

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Co-Surgeon and Team Surgeon Coverage Criteria

Co-Surgeon and Team Surgeon coverage criteria

Coverage and payment rules for Co-Surgeon (modifier 62) and Team Surgeon (modifier 66) services as aligned to CMS NPFS:

Co-Surgeon and Team Surgeon eligibility is determined by CMS NPFS status indicators: codes with NPFS Co-Surgeon or Team Surgeon status indicators 1 or 2 are eligible for the respective service modifiers (62 for Co-Surgeon, 66 for Team Surgeon).

ALL of the following

Each Co-Surgeon must submit the same CPT code with modifier 62 for the same date of service.
For eligible Co-Surgeon services, UnitedHealthcare Medicare Advantage will reimburse each Co-Surgeon 63% of the Allowable Amount, subject to multiple procedure reductions where applicable.
The Allowable Amount is determined independently for each surgeon and is calculated from the Allowable Amount that would be given to that surgeon performing the surgery without a Co-Surgeon.

ALL of the following

Each Team Surgeon must submit the same CPT code with modifier 66 for the same date of service.
Each Team Surgeon is required to submit written medical documentation describing the specific surgeon's involvement in the total procedure.
For eligible Team Surgeon services, UnitedHealthcare Medicare Advantage will review submissions and supporting documentation and make reimbursement decisions on a case-by-case basis.

ALL of the following

UnitedHealthcare Medicare Advantage does not reimburse Assistant Surgeon services (modifiers 80, 81, 82, or AS) for procedures where Co-Surgeon reimbursement has been provided for the same surgical procedure and encounter.
If a Co-Surgeon acts as an Assistant Surgeon for additional procedure(s) during the same surgical session, those additional procedures may be reimbursable when eligible per NPFS Assistant Surgeon indicators and when billed with separate procedure codes and the appropriate assistant modifier (e.g., 80 or 82).

ALL of the following

For simultaneous bilateral procedures (each surgeon performs the same procedure on opposite sides), each surgeon should report the procedures with modifiers 50 and 62.
Assistant Surgeon services will not be reimbursed in addition to simultaneous bilateral Co-Surgeon submissions.

ALL of the following

Multiple procedure reductions apply when physicians bill multiple CPT codes eligible for reductions during the same encounter; Co-Surgeon reimbursement is subject to these reductions as applicable.

ALL of the following

Team Surgeon submissions must include written medical documentation describing each surgeon's involvement; UnitedHealthcare Medicare Advantage will review documentation and make reimbursement determinations on a case-by-case basis.

ALL of the following

NPFS Co-Surgeon indicators: 1 = Co-Surgeons could be paid though supporting documentation is required to establish medical necessity; 2 = Co-Surgeons permitted and no documentation required if two-specialty requirement is met.
NPFS Team Surgeon indicators: 1 = Team Surgeons could be paid though supporting documentation required to establish medical necessity; pay by report; 2 = Team Surgeons permitted; pay by report.

Modifiers, CPT/NPFS References, and Eligibility Indicators

Relevant modifiers and CPT/NPFS referencesModifier | CPT | mixed

62	Co-Surgeon modifier
66	Team Surgeon modifier
50	Bilateral procedure modifier
80	Assistant Surgeon
81	Minimum Assistant Surgeon
82	Assistant Surgeon (when qualified resident not available)
AS	Physician assistant, nurse practitioner, or clinical nurse specialist services

NPFS eligibility indicator — Codes with NPFS Co‑Surgeon or Team Surgeon status indicators 1 or 2 are eligible.

NPFS eligibility indicatorCodes with NPFS Co-Surgeon or Team Surgeon status indicators 1 or 2 are eligible for Co‑Surgeon (modifier 62) or Team Surgeon (modifier 66) reporting.

Indicator 1 (Co-Surgeon)Co‑Surgeons could be paid but supporting documentation is required to establish medical necessity of two surgeons for the procedure.

Indicator 2 (Co-Surgeon)Co‑Surgeons permitted and no documentation required if the two‑specialty requirement is met.

Indicator 1 (Team Surgeon)Team Surgeons could be paid but supporting documentation is required to establish medical necessity of a team; pay by report.

Indicator 2 (Team Surgeon)Team Surgeons permitted; pay by report.

Documentation, Submission, and Policy Update Notices

Documentation Required

Documentation and submission requirements for Team Surgeons

Each Team Surgeon must submit written medical documentation describing that surgeon's specific involvement in the total procedure; UnitedHealthcare Medicare Advantage will review each submission with its medical documentation and make reimbursement decisions on a case-by-case basis.

Submit the same CPT code with modifier 66 for the same date of service.
Include detailed, written documentation of the specific surgeon’s role for the total procedure to support pay-by-report determinations.

Note

Policy updates and monitoring

UnitedHealthcare Medicare Advantage may modify this reimbursement policy at any time to comply with changes in CMS policy and other national coding guidelines; providers should monitor CMS and local carrier websites for updates and may sign up for regular distributions from CMS or their local carrier.

Policy versions will be published on the UnitedHealthcare Medicare Advantage website.

Key Definitions

Allowable Amount

DefinitionAllowable Amount: the dollar amount eligible for reimbursement to the physician or other qualified health care professional on the claim (examples include contracted rate, reasonable charge, or billed charges as applicable). For percent of charge or discount contracts, the Allowable Amount is determined as the billed amount less the discount.

Applies toPhysician or other qualified health care professional reimbursements reported on the claim.

Determination examplesContracted rate, reasonable charge, or billed charges; percent or discount contracts use billed amount less discount.

Co‑Surgeons

DefinitionCo‑Surgeons: several physicians (usually with different specialties) working together as primary surgeons performing distinct part(s) of a procedure; claims submitted by Co‑Surgeons are identified with modifier 62.

Payment implication