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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyHealthy Blue Louisiana Modifier 62 Policy | OpenPa…
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    CurrentHealthy Blue LouisianaPolicy G-06027

    Reimbursement Policy Modifier 62

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    This policy governs reimbursement and claim-submission requirements when two surgeons from different specialties perform distinct portions of the same procedure during one operative session for Healthy Blue Louisiana Medicaid Managed Care.

    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyReimbursement Policy Modifier 62
    Policy CodePolicy G-06027
    Change TypeNo material change
    Effective DateMar 26, 2026
    Last ReviewMar 26, 2026
    Next Review DateNot specified
    Key ActionBill each eligible co-surgeon’s claim using the same procedure code with modifier 62 when two surgeons from different specialties perform distinct portions of the procedure during the same operative session.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    80%Maximum reimbursement per eligible co-surgeon
    2Claims must use the same procedure code with modifier 62
    Different specialtiesRequired specialty relationship
    1 sessionRequired operative timing
    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyReimbursement Policy Modifier 62
    Policy CodePolicy G-06027
    Change TypeNo material change
    Effective DateMar 26, 2026
    Last ReviewMar 26, 2026
    Next Review DateNot specified
    Key ActionBill each eligible co-surgeon’s claim using the same procedure code with modifier 62 when two surgeons from different specialties perform distinct portions of the procedure during the same operative session.
    SourceLink
    On This Page
    Modifier 62 Co-Surgeon Reimbursement CriteriaModifier and Reimbursement CodingClaim Submission RequirementsKey Modifier 62 Terms

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Modifier 62 Co-Surgeon Reimbursement Criteria

    Modifier 62 Co-Surgeon Eligibility and Billing Conditions

    Procedures eligible for co-surgeon reimbursement are reimbursable when all applicable criteria below are met, unless provider, state, federal, CMS, contractual, or other applicable requirements indicate otherwise.

    ALL of the following

    • The procedure is eligible for co-surgeon reimbursement.
    • Two surgeons work together as primary surgeons during the same operative session and perform distinct parts of the procedure.
    • The co-surgeons are from different specialties.
    • Each surgeon reports the same procedure code once with modifier 62.
    • Modifier 62 is appended to any associated add-on code(s) for the procedure when both surgeons continue to work together as primary surgeons.
    • Each surgeon reports his or her distinct operative work.

    Applicable reimbursement or exception condition

    • Reimbursement to each surgeon is the lower of billed charges or 80% of the applicable fee schedule or contracted/negotiated rate.
    • Provider, state, federal, CMS, contractual, or other applicable requirements indicate a different treatment.

    Additional Procedure and Assistant-Surgeon Rules

    Additional procedures, assistant-surgeon services, and multiple-procedure rules are applied separately as described below.

    Additional procedures during the same surgical session

    • If additional procedure(s), including add-on procedure(s), are performed during the same surgical session, separate procedure code(s) may also be reported with modifier 62 added when the co-surgeons continue to perform the additional services as primary surgeons.
    • If a co-surgeon acts as an assistant in performing additional procedure(s) that are not appropriately reported with modifier 62, the assistant services may be reported with separate procedure code(s) and modifier 80 or modifier 82, as appropriate.

    Multiple-procedure treatment

    • Multiple-procedure rules and applicable fee reductions apply when multiple procedures are performed during the same surgical session.

    Assistant-surgeon exception

    Modifier and Reimbursement Coding

    Co-surgeon modifierModifierCovered
    62Modifier 62 identifies two surgeons working together as primary surgeons on distinct portions of a procedure.
    Assistant-surgeon modifiersModifier
    80Assistant surgeon modifier for additional procedures when a co-surgeon acts as an assistant.
    82Assistant surgeon modifier used as appropriate for additional procedures when a co-surgeon acts as an assistant.
    Co-surgeon reimbursement
    Reimbursement basisEach eligible co-surgeon is reimbursed at the lower of billed charges or the applicable payment rate.
    Applicable rateThe applicable payment rate is 80% of the fee schedule or contracted/negotiated rate.
    Co-surgeon conditionsCo-surgeons must be from different specialties and perform surgical services during the same operative session.

    Claim Submission Requirements

    Billing Rule

    Submit matching modifier 62 claims

    When two surgeons from different specialties perform distinct portions of an eligible procedure as primary surgeons during the same operative session, each surgeon must submit the same procedure code with modifier 62.

    Documentation Required

    Verify co-surgeon eligibility

    Before billing, confirm that the procedure is eligible for co-surgeon reimbursement and that no provider, state, federal, CMS, or contract requirement indicates otherwise.

    Billing Rule

    Report distinct operative work

    Each surgeon should report their distinct operative work by adding modifier 62 to the procedure code and any associated add-on codes, provided both surgeons continue working together as primary surgeons. Report the co-surgery once using the same procedure code.

    Billing Rule

    Report assistant services separately

    If a co-surgeon acts as an assistant for additional procedures that are not appropriately reported with modifier 62, report the separate procedure code with modifier 80 or modifier 82, as appropriate.

    Billing Rule

    Apply additional procedure rules

    Apply assistant-surgeon rules and fee reductions when a co-surgeon acts as an assistant for additional procedures during the same surgical session. Apply multiple-procedure rules and fee reductions when multiple procedures are performed; assistant-surgeon rules do not apply to procedures appropriately billed with modifier 62.

    Denial Risk

    Avoid duplicate-service denial risk

    Use modifier 62 appropriately on both surgeons’ claims. If one or both surgeons fail to do so, one surgeon may receive 100% of the applicable fee schedule or negotiated/contracted rate while the other claim may be denied or pended as a duplicate or suspected duplicate service.

    Key Modifier 62 Terms

    Modifier 62
    Primary surgeonsModifier 62 applies when two surgeons work together as primary surgeons.
    Distinct operative workEach surgeon must perform and report a distinct part of the procedure.
    Claim reportingEach surgeon reports the same procedure code with modifier 62; associated add-on codes may also be reported with modifier 62 while both surgeons continue working together as primary surgeons.
    Co-surgeon acting as assistant
    Additional proceduresA co-surgeon may perform additional procedures during the same surgical session as an assistant rather than as a co-surgeon.
    Separate reportingAssistant services for procedures not reported with modifier 62 may be submitted under separate procedure codes.
    Applicable modifiersUse modifier 80 or modifier 82, as appropriate, for those assistant services.
    Assistant-surgeon rules do not apply to procedures appropriately billed with modifier 62.
  1. Assistant-surgeon rules apply when a co-surgeon performs additional procedure(s) as an assistant and those services are not appropriately reported with modifier 62.

    2. Modifier 62 billing outcome

    • Both surgeons appropriately bill the same procedure code(s) with modifier 62.
    • If one or both surgeons fail to use modifier 62 appropriately, one surgeon may receive 100% of the applicable fee schedule or negotiated/contracted rate, while the other surgeon's claim may be denied or pended due to a duplicate or suspected duplicate service.