CurrentUnitedHealthcarePolicy 2025R9010B

Co‑Surgeon and Team Surgeon reimbursement for CMS 1500 claims

Defines UnitedHealthcare Medicare Advantage reimbursement policy for Co‑Surgeon (modifier 62) and Team Surgeon (modifier 66) services billed on CMS 1500 forms and applies to network physicians and qualified health care professionals in Medicare Advantage plans.

Policy Summary

PayerUnitedHealthcare

PolicyCo‑Surgeon and Team Surgeon reimbursement for CMS 1500 claims

Policy CodePolicy 2025R9010B

Change TypeNon‑material administrative and definition updates

Effective Date

Next Review Date

Key ActionSubmit written medical documentation describing each surgeon's involvement when billing Team Surgeon or when Co‑Surgeon codes require documentation to establish medical necessity.

SourceLink

POLICY UPDATE CHANGES

Policy section and definitions updated in the 9/5/2025 version.

Application section updated in 6/1/2024 version.

History entries prior to 6/1/2023 archived in 6/1/2025 version.

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

8modifier codes referenced

1 or 2NPFS indicators eligible

Co‑Surgeon and Team Surgeon Coverage Criteria

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Co‑Surgeon and Team Surgeon coverage criteria

Coverage and payment rules for Co‑Surgeon (modifier 62) and Team Surgeon (modifier 66) services billed on CMS 1500 forms.

Codes eligible: All CPT codes listed in the CMS NPFS with Co‑Surgeon status indicator 1 or 2 are eligible for Co‑Surgeon services when reported with modifier 62.

Codes eligible: All CPT codes listed in the CMS NPFS with Team Surgeon status indicator 1 or 2 are eligible for Team Surgeon services when reported with modifier 66.

Submission format: Each Co‑Surgeon or Team Surgeon should submit the same CPT code with the appropriate modifier (62 for Co‑Surgeon; 66 for Team Surgeon) for the same date of service.

ALL of the following

UnitedHealthcare Medicare Advantage will reimburse each eligible Co‑Surgeon 63% of the Allowable Amount.
The Allowable Amount is determined independently for each surgeon and calculated from the Allowable Amount that would be given to that surgeon performing the surgery without a Co‑Surgeon.
Payments are subject to additional multiple procedure reductions when applicable.

ALL of the following

Each Team Surgeon must submit written medical documentation describing the specific surgeon's involvement in the total procedure.
UnitedHealthcare Medicare Advantage will review Team Surgeon submissions and supporting documentation and make reimbursement decisions on a case‑by‑case basis (pay by report).

ALL of the following

When NPFS Co‑Surgeon indicator = 1, supporting documentation is required to establish the medical necessity of two surgeons for the procedure.
When NPFS Co‑Surgeon indicator = 2, no documentation is required if the two‑specialty requirement is met.

ALL of the following

UnitedHealthcare does not reimburse Assistant Surgeon services (modifiers 80, 81, 82, AS) for procedures where reimbursement has been provided for eligible Co‑Surgeon services using the same surgical procedure code during the same encounter.
If a Co‑Surgeon acts as an Assistant Surgeon for additional procedures during the same surgical session, those additional procedures may be reimbursable when reported with separate procedure codes and appropriate assistant surgeon modifiers (80 or 82), if eligible per NPFS Assistant Surgeon indicators.

ALL of the following

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

ALL of the following

Co‑Surgeons are defined as physicians (usually different specialties) and non‑physicians are not reimbursed for performing Co‑Surgeon services per CMS NPFS guidance and this policy.

Modifiers and Code References

Relevant modifier and code referencesModifier

50	Bilateral procedure modifier
62	Co‑Surgeon modifier
66	Team Surgeon 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 — Co‑Surgeon or Team Surgeon

Eligibility ruleCodes with NPFS Co‑Surgeon status indicators 1 or 2 are eligible for Co‑Surgeon services when billed with modifier 62.

Indicator 1 meaning1 = Co‑Surgeons could be paid, though supporting documentation is required to establish medical necessity of two surgeons for the procedure.

Indicator 2 meaning2 = Co‑Surgeons permitted and no documentation required if the two‑specialty requirement is met.

Documentation and Submission Requirements

Documentation Required

Team Surgeon documentation requirements

Modifier 66 identifies Team Surgeons involved in the care of a patient during surgery. Each Team Surgeon should 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 services included on the Team Surgeon Eligible List, UnitedHealthcare Medicare Advantage will review each submission with its appropriate medical documentation and will make reimbursement decisions on a case-by-case basis.

Each Team Surgeon must submit the same CPT code with modifier 66 on the same date of service.
Written medical documentation must describe each surgeon's specific involvement in the total procedure.
UnitedHealthcare Medicare Advantage will review submissions for Team Surgeon–eligible services on a case-by-case basis.

Note

Policy modification and prior authorization note

UnitedHealthcare Medicare Advantage may modify this reimbursement policy at any time to comply with changes in CMS policy and other national standard coding guidelines by publishing a new version of the reimbursement policy on this website. The information presented is accurate and current as of the date of publication; providers are encouraged to monitor CMS and local carrier websites and sign up for CMS distributions for policy or regulatory changes. UnitedHealthcare's Medicare Advantage reimbursement policies do not include notations regarding prior authorization requirements.

Policy subject to change to maintain CMS compliance.
Providers should refer to CMS or local carrier websites for updates and billing requirements.
UnitedHealthcare Medicare Advantage reimbursement policies do not indicate prior authorization requirements.

Key Definitions

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, whichever is applicable).

Percent/discount contractsFor percent of charge or discount contracts, the Allowable Amount is the billed amount less the discount.

Per‑surgeon determinationThe Allowable Amount is determined independently for each surgeon (calculated from the amount that would be given to that surgeon performing the surgery without a Co‑Surgeon).

Co‑Surgeons — definition and arrangements

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.

Typical arrangementUsually involves two surgeons in different specialties each performing distinct portions of the operation.

Documentation requirementWhen NPFS Co‑Surgeon indicator = 1, supporting documentation is required to establish medical necessity for two surgeons.

Team Surgeons — definition and identification

DefinitionTeam Surgeons: three or more physicians working together during an operative session in the management of a specific surgical procedure; claims submitted by Team Surgeons are identified with modifier 66.

NPFS indicatorsCodes with NPFS Team Surgeon status indicators 1 or 2 are eligible for Team Surgeon services; indicator 1 requires supporting documentation (pay by report); indicator 2 permits payment (pay by report).

Documentation requirementEach Team Surgeon must submit written medical documentation describing specific involvement when required to support pay‑by‑report determinations.

Assistant Surgeon — definition

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

Modifier referencesAssistant Surgeon services are reported with modifiers such as 80, 81, 82 or AS and are not reimbursed in addition to eligible Co‑Surgeon payments for the same procedure and encounter.

Simultaneous bilateral noteAssistant Surgeon services will not be reimbursed in addition to simultaneous bilateral submissions when each surgeon reports modifiers 50 and 62.

Same Individual Physician or Other Qualified Health Care Professional — definition

DefinitionSame Individual Physician or Other Qualified Health Care Professional: the same individual rendering health care services reporting the same National Provider Identifier (NPI).

Implication for claimsReporting the same NPI identifies services as rendered by the same individual provider for billing and reimbursement determinations.

Use in policyUsed to determine whether multiple reported services on a claim were provided by the same practitioner versus distinct providers.