CurrentMolina HealthcarePolicy N/A

Co-Surgeon and Team Surgeon Reimbursement Policy

This document governs Molina Healthcare's reimbursement rules for Co-Surgeon (modifier 62) and Team Surgeon (modifier 66) services billed on CMS-1500 (and equivalents), applying across products and to network and non-network physicians and other qualified healthcare professionals.

Policy Summary

PayerMolina Healthcare

PolicyCo-Surgeon and Team Surgeon Reimbursement Policy

Policy CodePolicy N/A

Change TypeAdministrative template update

Effective DateN/A

Next Review DateAug 4, 2025

Key ActionTeam Surgeon services require written medical documentation describing each surgeon's specific involvement; modifiers are subject to pre- and/or post-payment audits for medical necessity.

SourceLink

POLICY UPDATE CHANGES

Updated template on 08/04/2025.

Updated template on 12/12/2024.

Initial creation of the policy on 08/16/2023.

63%Co‑Surgeon rate of Allowable Amount

62Co‑Surgeon modifier

66Team Surgeon modifier

NPFS 1/2Eligible code status

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Co-/Team Surgeon Coverage Criteria

Covered when ALL of the following criteria are met:

ALL of the following

ALL of the following
- Same CPT code billed by each Co-Surgeon on the same service date with modifier 62.
- Each Co-Surgeon is reimbursed at 63% of the Allowable Amount, determined independently for each surgeon.
- Additional multiple procedure reductions may apply per Molina's Multiple Procedure Reduction rules.
ALL of the following
- Same CPT code billed by each Team Surgeon on the same service date with modifier 66.
- Written medical documentation must be provided describing each Team Surgeon’s specific involvement in the procedure.
- Reimbursement for services on the Team Surgeon Eligible List is determined case-by-case after review of submitted medical documentation.
ALL of the following
- Codes with CMS NPFS status indicators '1' or '2' are considered eligible for Co-Surgeon (modifier 62) or Team Surgeon (modifier 66) services.
- Payment indicators for HCPCS codes G0412-G0415 are applied when settling CPT codes 27215-27218.
ALL of the following
- Multiple procedure reductions apply when multiple physicians bill eligible CPT codes; Molina follows CMS guidelines for reductions.
- Assistant Surgeon services (modifiers 80, 81, 82, or AS) are not reimbursed when eligible Co-Surgeon services for the same surgical procedure are provided during the same encounter.
- Procedures performed by a Co-Surgeon acting as an Assistant Surgeon are reimbursable only when reported with the separate procedure code(s) and modifier 80 or 82, as appropriate.
ALL of the following
- Surgeons performing the same procedure on opposite sides should report simultaneous bilateral procedures with modifiers 50 and 62.
- Assistant Surgeon services are not reimbursed except as described for simultaneous bilateral submissions.
ALL of the following
- Modifiers identifying assistant surgeon, co-surgeon, and team surgeries are subject to pre- and/or post-payment audits for medical necessity.
- Medical necessity determinations reference ACS Physicians as Assistants at Surgery eligibility list, CMS NPFS, and patient health status.
- Charges for services that do not meet medical necessity criteria will be denied.

ref

Relevant Codes, Modifiers, and Reimbursement

Referenced HCPCS/CPT crosswalkmixed

G0412-G0415	HCPCS codes with payment indicators applied when settling CPT codes 27215-27218
27215-27218	CPT codes referenced for application of G0412-G0415 payment indicators

Required modifiersModifierCovered

modifier 62	Co-Surgeon identifier
modifier 66	Team Surgeon identifier

Co‑Surgeon reimbursement percentage

Allowable percentage per Co-Surgeon63% of the Allowable Amount for each Co-Surgeon (reimbursed independently)

Billing requirementEach Co-Surgeon must bill the same CPT code with modifier 62 on the same service date

Basis for percentageReimbursable percentage is based on CMS rate (CMS allows ~62.5% to each Co-Surgeon)

Multiple procedure reductionsAdditional multiple procedure reductions may apply per policy (see Multiple Procedure Reduction section)

Documentation, Audit, and Denial Guidance

Documentation Required

Team Surgeon Documentation & Audit Requirements

Modifier 66 identifies Team Surgeons involved in patient care during a surgical procedure. Each Team Surgeon must bill the same CPT code with modifier 66 on the same date of service and provide written medical documentation describing their specific involvement in the procedure. Reimbursement for services on the Team Surgeon Eligible List is determined case-by-case after review of submitted documentation.

Affected codes: CPT codes billed with Modifier 66 (Team Surgeon).
Documentation required: contemporaneous operative note, clearly delineated surgeon role/activities, time/date, patient condition, and rationale for team approach.

Denial Risk

Denial Risk for Lack of Medical Necessity

Modifiers that identify assistant surgeon, co-surgeon, and team surgeon services (including Modifier 66) are subject to pre- and/or post-payment audit and may be denied if medical necessity or documentation is insufficient. Charges for services that do not meet medical necessity criteria (per ACS eligibility guidance, CMS NPFS, and patient health status) will be denied.

Denial risk applies when documentation does not clearly support the need for a team surgeon/co-surgeon/assistant.
Ensure documentation ties the level of service to patient health status and references clinical need per ACS/CMS guidance.

Key Term Definitions

Co‑Surgeons (modifier 62)

IdentifierModifier 62 identifies Co‑Surgeons on claims

Role descriptionSeveral physicians (usually with different specialties) working together as primary surgeons performing distinct part(s) of a procedure

Billing practiceCo‑Surgeons should bill the same CPT code with modifier 62 for the same service date

Team Surgeons (modifier 66)

IdentifierModifier 66 identifies Team Surgeons on claims

Role descriptionThree or more physicians (with different or same specialties) working together during an operative session for management of a specific surgical procedure

Documentation requirementTeam Surgeon billing requires same CPT code with modifier 66 and written medical documentation describing specific involvement (per coverage criteria)

Allowable Amount — definition

DefinitionAllowable Amount = the dollar amount eligible for reimbursement to the physician or other qualified health care professional on the claim (examples: contracted rate, reasonable charge, or billed charges)

ApplicationUsed as the base for calculating Co‑Surgeon reimbursement (e.g., 63% of the Allowable Amount)

DeterminationThe Allowable Amount may reflect contracted rates, reasonable charges, or billed charges depending on the agreement or payment methodology

Assistant Surgeon — definition

DefinitionAssistant Surgeon = a physician or other qualified health care professional who is assisting the physician performing a surgical procedure

ModifiersAssistant Surgeon services are identified by modifiers 80, 81, 82, or AS per the policy

Interaction with Co/Team SurgeonsAssistant Surgeon services are not reimbursed when eligible Co‑Surgeon services for the same procedure are provided during the same encounter, except as described for simultaneous bilateral submissions