CurrentPremera BluecrossPolicy Modifier 62 Two Surgeons.CPPP.009.v3.1

Modifier 62 Two Surgeons (Co-surgeon) reimbursement

Defines when Premera recognizes and reimburses services billed with modifier 62 for co-surgeon services, and the related billing and documentation requirements for providers across Premera and affiliated lines of business.

Policy Summary

PayerPremera Bluecross

PolicyModifier 62 Two Surgeons (Co-surgeon) reimbursement

Policy CodePolicy Modifier 62 Two Surgeons.CPPP.009.v3.1

Change TypeClarifiedRevised

Effective Date

Next Review Date

Key ActionProviders must append modifier 62 to the same procedure code(s) when acting as co-surgeons and ensure each co-surgeon’s operative report documents the distinct portions performed and identifies the other co-surgeon.

SourceLink

POLICY UPDATE CHANGES

Revised Purpose to indicate policy refers to services billed on CMS-1500 or 837P claim forms and referenced CMS NPFS for co-surgeon indicators.

Clarified that when a co-surgery has been identified, all associated surgeon claims must be submitted with the same procedure code and modifier 62.

Clarified that the operative report must identify what services were rendered as primary, co- or assistant surgeon.

62.5%Reimbursement per co-surgeon

MultipleReview history entries

5Lines of business covered

Co-surgeon Coverage Criteria

Co-surgeon coverage criteria

Covered when ALL of the following are met:

ALL of the following

Two surgeons provide co-surgeon services due to the complex nature of the procedure(s) and/or the patient’s condition; the additional physician is not acting as an assistant at surgery (Co-surgeons perform distinct or simultaneous parts of the same procedure).
Each co-surgeon documents their own distinctive part of the operative work in individual operative notes; each operative report must identify which portion(s) were performed as co-surgeon or primary surgeon and must identify the other co-surgeon; operative reports must be made available upon request.
Both surgeons bill the same surgical procedure code(s) and same diagnosis code(s), and each provider appends modifier 62 to the same procedure code(s).

Policy Summary

PayerPremera Bluecross

PolicyModifier 62 Two Surgeons (Co-surgeon) reimbursement

Policy CodePolicy Modifier 62 Two Surgeons.CPPP.009.v3.1

Change TypeClarifiedRevised

Effective Date

Next Review Date

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Procedure eligibility for co-surgeon payment is determined primarily by the CMS NPFS Co-Surgeons indicator: 0 = co-surgeons not permitted; 1 = co-surgeons may be paid (supporting documentation required); 2 = co-surgeons permitted (documentation not required); 9 = co-surgeon concept does not apply (other resources may be used to determine exceptions).

When simultaneous bilateral surgeries are performed, each surgeon must report the same procedure code with modifiers 50 and 62 to indicate co-surgery was performed.

When a co-surgery has been identified, all claims submitted with the same surgical procedure code must be billed with modifier 62; failure to bill all associated surgeon claims with modifier 62 may result in denial.

Reimbursement for services appended with modifier 62 will be adjusted to 62.5% of the provider’s applicable Fee Schedule allowed amount for each surgeon’s distinct service performed.

Relevant Modifiers, Codes, and NPFS Indicator

Relevant modifiers and coding rulesModifierCovered

Modifier 62	Two surgeons; co-surgeons
Modifier 50	Bilateral procedure (used with simultaneous bilateral surgeries)
Modifier 80/81/82/AS	Assistant surgeon modifiers (used when second surgeon is assistant, not co-surgeon)

NPFS Co-surgeon indicator

NPFS co-surgeon indicator values0 = Co-surgeons not permitted for the procedure; 1 = Co-surgeons may be paid (supporting documentation required); 2 = Co-surgeons permitted (documentation not required); 9 = Co-surgeon concept does not apply

Determines eligibility for co-surgeon paymentPlan primarily determines whether codes are eligible/billable for co-surgeons based on the Co-Surgeons indicator in the current CMS NPFS Relative Value Guide

Use for procedures billed on CMS claim formsApplies to services submitted on CMS-1500 paper claim form or 837P electronic claim form

Codes with indicator 9Codes identified with indicator 9 may require consultation of other professional resources (e.g., AMA CPT codebook, professional societies) to make exceptions

Documentation and Billing Requirements for Co-surgeons

Billing Rule

Append modifier 62 to the same procedure code(s) for all co‑surgeon claims

When acting as a co‑surgeon, providers must bill the identical surgical procedure code(s) and append modifier 62 to those same procedure code(s) on all associated claims for the co‑surgery. Operative reports for each co‑surgeon must document the distinct portions performed, identify the other co‑surgeon, and be made available upon request. Failure to submit all associated claims with modifier 62 may result in claim denial.

Bill the same procedure code(s) and same diagnosis code(s) as the other co‑surgeon.
Append modifier 62 to the same procedure code(s) on all associated claims for the co‑surgery.
Ensure each surgeon’s operative report documents the distinct part(s) performed and identifies the other co‑surgeon.
Make operative reports available for review upon request.

Definitions

Two surgeons / Co-surgeon services

Definition of co-surgeon servicesTwo surgeons provide services due to the complexity of the procedure and/or patient's condition where the additional physician is not acting as an assistant and both perform distinct or simultaneous parts of the same procedure

Operative documentation requirementEach surgeon reports their own distinctive part of the operative work in their individual operative notes

Billing requirementsBoth providers bill the same surgical procedure code(s), same diagnosis code(s), and append modifier 62 to the same procedure code(s)

SpecialtyCo-surgeons may be of different specialties and different surgical skills/expertise when working together as primary surgeons