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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyHealthy Blue Louisiana Modifier 62 Update | 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 act as co-surgeons during the same operative session for providers billing Healthy Blue Louisiana, subject to applicable provider, state, federal, CMS, and contractual requirements.

    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyReimbursement Policy Modifier 62
    Policy CodePolicy G-06027
    Change TypeNo material change
    Effective Date03/26/2026
    Last ReviewMar 26, 2026
    Next Review DateN/A
    Key ActionBill each surgeon's eligible co-surgeon procedure using the same procedure code with modifier 62 when applicable.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    62.5%Reimbursement for each eligible co-surgeon
    2Surgeons from different specialties required for co-surgeon billing
    Same sessionRequired timing for co-surgeon services
    100%Potential payment to one surgeon if modifier use is incorrect

    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.

    03/26/2026
    Review approved with no changes

    Modifier 62 Eligibility and Reimbursement Rules

    Eligible Modifier 62 Co-Surgeon Reimbursement

    Modifier 62 procedures are eligible for reimbursement when ALL of the following conditions are met, unless provider, state, federal, CMS, or applicable contract requirements provide otherwise.

    ALL of the following

    • The procedure is eligible for co-surgeon reimbursement.
    • The co-surgeons are from different specialties.
    • Both co-surgeons perform surgical services during the same operative session.
    • Each surgeon bills the same procedure code(s) with modifier 62, when applicable.

      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 claim may be denied or pended for a duplicate or suspected duplicate service.

    • Reimbursement is subject to applicable provider, state, federal, CMS, and contractual or negotiated requirements.

    Additional Procedure and Assistant Rules

    Assistant surgeon and multiple-procedure rules and applicable fee reductions apply in the following circumstances.

    ANY of the following

    • A co-surgeon acts as an assistant while performing additional procedure(s) during the same surgical session.

      Assistant surgeon rules and applicable fee reductions apply to the additional procedure(s). Assistant surgeon rules do not apply to procedures appropriately billed with modifier 62.

    • Multiple procedures are performed during the same surgical session.

      Multiple-procedure rules and applicable fee reductions apply.

    • The surgeons perform different procedures during the same surgical session.

      The health plan does not consider surgeons performing different procedures to be co-surgeons; modifier 62 is not required for those services.

    Coding and Reimbursement Details

    Co-surgeon modifierModifierCovered
    62Modifier 62 for two surgeons working together as primary surgeons on distinct parts of a procedure
    Assistant surgeon modifiers for additional proceduresModifier
    80Assistant surgeon modifier
    82Assistant surgeon modifier used as appropriate
    Acceptable claim code systemsmixed
    CPTCurrent Procedural Terminology codes
    HCPCSHealthcare Common Procedure Coding System codes
    RevenueRevenue codes
    Co-surgeon reimbursement
    Reimbursement per co-surgeon62.5% of the applicable fee schedule or contracted/negotiated rate
    Payment basisEach surgeon’s reimbursement is based on the applicable fee schedule or contracted/negotiated rate
    Eligible billingThe policy allows reimbursement for procedures eligible for co-surgeons when billed with modifier 62, subject to applicable requirements
    Co-surgeon specialty requirements
    Required specialtiesCo-surgeons must be two surgeons from different specialties
    Primary-surgeon role

    Claim Submission and Documentation Actions

    Billing Rule

    Submit matching modifier 62 claims

    Bill each surgeon’s eligible co-surgeon procedure using the same procedure code with modifier 62, when applicable.

    • Reimbursement to each surgeon is based on 62.5% of the applicable fee schedule or contracted/negotiated rate.
    Billing Rule

    Apply co-surgeon criteria

    Use modifier 62 only when two surgeons from different specialties perform as primary surgeons during the same operative session. Surgeons performing different procedures during the same session are not considered co-surgeons, and modifier 62 is not required.

    • Each surgeon must report the same procedure code with modifier 62 when applicable.

    Key Terms

    Modifier 62
    Modifier 62Used when two surgeons work together as primary surgeons performing distinct parts of a procedure
    Distinct operative workEach surgeon reports their distinct operative work by adding modifier 62 to the procedure code and applicable associated add-on codes
    Co-surgery reportingEach surgeon reports the co-surgery once using the same procedure code
    Co-surgeons
    Co-surgeonsSurgeons from different specialties performing surgical services during the same operative session as primary surgeons
    Same procedure reportingEach surgeon reports the same procedure code with modifier 62 when applicable
    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyReimbursement Policy Modifier 62
    Policy CodePolicy G-06027
    Change TypeNo material change
    Effective Date03/26/2026
    Last ReviewMar 26, 2026
    Next Review DateN/A
    Key ActionBill each surgeon's eligible co-surgeon procedure using the same procedure code with modifier 62 when applicable.
    SourceLink
    On This Page
    Modifier 62 Eligibility and Reimbursement RulesCoding and Reimbursement DetailsClaim Submission and Documentation ActionsKey Terms
    Both surgeons must perform surgical services as primary surgeons
    Different proceduresSurgeons performing different procedures during the same surgical session are not considered co-surgeons
    Operative timing
    Required timingCo-surgeons must perform surgical services during the same operative session
    Session-specific billingEach surgeon must bill the same procedure code or codes with modifier 62 when applicable
    Different procedures in one sessionPerforming different procedures during the same session does not establish co-surgeon status, and modifier 62 is not required
    Denial Risk

    Avoid duplicate-service denial risk

    Incorrect or missing modifier 62 use may result in one surgeon receiving 100% of the applicable fee schedule or negotiated/contracted rate while the other surgeon’s claim is denied or pended as a duplicate or suspected duplicate service.

    • Use the modifier appropriately on both surgeons’ claims to reduce duplicate-service denial risk.
    Billing Rule

    Report assistant services separately

    When a co-surgeon acts as an assistant for additional procedures during the same surgical session that are not reported with modifier 62, report the separate procedures with modifier 80 or modifier 82, as appropriate.

    • Assistant surgeon rules do not apply to procedures appropriately billed with modifier 62.
    • Assistant surgeon and multiple-procedure rules and fee reductions may apply.
    Documentation Required

    Support billed services

    Use proper billing and submission guidelines, including industry-standard, compliant codes supported by the medical record or office notes. Claims may be rejected or denied, recouped, or adjusted if coding and billing guidelines are not followed.

    • Use CPT, HCPCS, and/or revenue codes as appropriate.
    • Ensure billed services and procedures are fully supported in the medical record and/or office notes.
    Separate procedures
    Surgeons performing different procedures during the same surgical session are not considered co-surgeons