CurrentUnitedHealthcarePolicy 2025R0052A

Co-Surgeon and Team Surgeon Reimbursement Policy (CMS 1500)

Governance of reimbursement for Co-Surgeon (modifier 62) and Team Surgeon (modifier 66) services for UnitedHealthcare Community Plan Medicaid products on CMS-1500 (professional) claims; applies to physicians and other qualified health care professionals submitting CMS1500 or electronic equivalent.

Policy Summary

PayerUnitedHealthcare

PolicyCo-Surgeon and Team Surgeon Reimbursement Policy (CMS 1500)

Policy CodePolicy 2025R0052A

Change TypeState exceptions and guideline revisions

Effective Date

Next Review Date

Key ActionSubmit same CPT code with modifier 62 for Co-Surgeons and provide written documentation for Team Surgeon (modifier 66) submissions for case-by-case review.

SourceLink

POLICY UPDATE CHANGES

State Exceptions section updated for Florida, Indiana, Kentucky, Mississippi, New Mexico, Washington DC, and Wisconsin at various dates.

Wisconsin added to State Exceptions.

New Mexico added to State Exceptions (total allowed value increased by 25% and each surgeon paid 50%).

Policy verbiage updated in Reimbursement Guidelines section.

62.5%Co-Surgeon default reimbursement

50%Modifier 62 in FL/KY

62.5%Modifier 66 in MS

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3Max providers at 100% (FL)

Co-Surgeon and Team Surgeon Coverage Criteria

Co-Surgeon and Team Surgeon coverage criteria

Covered when the following billing, documentation, and state-specific rules are met:

ALL of the following

ALL of the following
- Submit the same CPT code with modifier 62 on the same date of service
  Each Co-Surgeon should submit the same CPT code with modifier 62 for the same date of service.
- Reimbursement calculated per surgeon from the Allowable Amount that would be given if performing the surgery without a Co-Surgeon
  The Allowable Amount is determined independently for each surgeon and is calculated from the Allowable Amount that would be given to that surgeon performing the surgery without a Co-Surgeon.
ALL of the following
- Reimbursed at 62.5% of the Allowable Amount to each surgeon
  Subject to additional multiple procedure reductions if applicable.
ALL of the following
- Submit the same CPT code with modifier 66 on the same date of service
- Provide written medical documentation describing the specific surgeon's involvement
  Each Team Surgeon is required to submit written medical documentation describing the specific surgeon's involvement; reimbursements reviewed case-by-case.
ALL of the following
- Eligibility determined from CMS NPFS Relative Value File status indicators
  All codes in the NPFS with status code indicators '1' or '2' for 'Co-Surgeons' or 'Team Surgeons' are considered eligible as indicated by modifiers 62 or 66.
- Adjudication mapping for CPT 27215-27218
  UnitedHealthcare applies payment indicators for HCPCS codes G0412 - G0415 when adjudicating CPT codes 27215-27218 for this policy.

ALL of the following

Assistant surgeon modifiers (80,81,82,AS) are not reimbursed when Co-Surgeon reimbursement is provided for the same procedure during the same encounter
If a Co-Surgeon acts as an Assistant Surgeon for additional procedure(s) during the same session, those additional procedures may be reimbursable when billed with separate procedure codes and the appropriate assistant modifier (80 or 82) if eligible per the Assistant Surgeon Eligible List.

ALL of the following

Each surgeon reports simultaneous bilateral procedures with modifiers 50 and 62
Assistant Surgeon services will not be reimbursed in addition to the simultaneous bilateral submission
Assistant Surgeon services will not be reimbursed in addition to the simultaneous bilateral submission as described in the policy.

ALL of the following

Multiple procedure reductions apply when physicians bill multiple CPT codes eligible for reductions
Co-Surgeon reimbursement remains subject to additional multiple procedure reductions if applicable.

Coding and Payment Indicators

HCPCS payment indicator mappingHCPCS

G0412-G0415

Payment indicators applied when adjudicating CPT codes 27215-27218

NPFS status indicators

NPFS status indicatorsAll codes in the NPFS with status code indicators '1' or '2' for 'Co-Surgeons' are considered eligible for Co-Surgeon services (modifier 62).

Team Surgeon eligibilityAll codes in the NPFS with status code indicators '1' or '2' for 'Team Surgeons' are considered eligible for Team Surgeon services (modifier 66).

Reference sourceEligibility lists are developed from the CMS NPFS Relative Value File 'CO -SURG' and 'TEAM SURG' columns (see CMS PFS Relative Value Files).

Billing, Documentation, and Payment Actions for Providers

Billing Rule

Co-Surgeon billing and reimbursement

Modifier 62 identifies a Co-Surgeon involved in the care of a patient at surgery. Each Co-Surgeon must submit the same CPT code with modifier 62 for the same date of service. In alignment with CMS, UnitedHealthcare will reimburse Co-Surgeon services at 62.5% of the Allowable Amount to each surgeon, subject to applicable multiple procedure reductions. The Allowable Amount is determined independently for each surgeon and is calculated from the Allowable Amount that would be given to that surgeon performing the surgery without a Co-Surgeon.

Submit identical CPT code with modifier 62 for each Co-Surgeon on same date of service
Reimbursement: 62.5% of the Allowable Amount to each Co-Surgeon (calculated independently)
Multiple procedure reductions may further adjust reimbursement (see Multiple Procedure Reductions)

Billing Rule

Assistant Surgeon exclusion with Co-Surgeon

UnitedHealthcare follows CMS guidance and does not reimburse Assistant Surgeon services (modifiers 80, 81, 82, or AS) for procedures when eligible Co-Surgeon reimbursement has been provided for the same surgical procedure code during the same encounter. If a Co-Surgeon subsequently functions as an Assistant Surgeon for additional, separately coded procedures during the same surgical session, those assistant services may be reimbursable (if eligible per the Assistant Surgeon Eligible List) when billed with the appropriate assistant modifier (80 or 82) and a separate procedure code.

Definitions

Allowable Amount

DefinitionAllowable Amount is 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).

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

ApplicabilityUsed to determine reimbursement amounts (e.g., Co-Surgeon/Team Surgeon payments are calculated as a percentage of the Allowable Amount).

Assistant Surgeon

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

Modifiers

Policy Changes and Revision History

2025-09-25policy_versionLatest

Policy version and date change; prior entries before 2023-09-25 were archived.

2024-10-06state_exception_added

Wisconsin added to State Exceptions (modifier 62 reimbursed at 100% per fee schedule).

2024-06-14state_exception_added

New Mexico added to State Exceptions (total allowed value increased by 25% and each surgeon paid 50%).

Policy Summary

PayerUnitedHealthcare

PolicyCo-Surgeon and Team Surgeon Reimbursement Policy (CMS 1500)

Policy CodePolicy 2025R0052A

Change TypeState exceptions and guideline revisions

Effective Date

Next Review Date

Key ActionSubmit same CPT code with modifier 62 for Co-Surgeons and provide written documentation for Team Surgeon (modifier 66) submissions for case-by-case review.

SourceLink

On This Page

Do not bill assistant surgeon modifiers (80, 81, 82, AS) for a procedure if Co-Surgeon reimbursement has been paid for that same procedure on the same date of service
If additional procedures (separately coded) are performed and the Co-Surgeon functions as an assistant on those separate procedures, bill the separate procedure codes with modifier 80 or 82 as appropriate
Reimbursement for such assistant services is contingent on eligibility per the Assistant Surgeon Eligible List

Billing Rule

Multiple procedure reductions

Multiple procedure reductions apply when one or more physicians bill multiple CPT codes that are eligible for reductions during the same encounter. Reduction rules affect Co-Surgeon and Team Surgeon claim submissions and may change the final reimbursable amount for each provider. See the Multiple Procedure Reductions section for specific ordering and payment percentage rules.

When multiple eligible CPT codes are billed by one or more physicians during the same encounter, standard multiple-procedure or multiple-provider reduction rules will be applied
These reductions can affect the Allowable Amount used to calculate each Co-Surgeon's 62.5% share

Assistant Surgeon services are identified by modifiers such as 80, 81, 82, or AS when billed (policy notes exclusion when Co-Surgeon reimbursement applies).

RoleProvides surgical assistance to the primary surgeon during the operative procedure; reimbursement rules differ from Co-Surgeon and Team Surgeon services.

Co-Surgeons

DefinitionCo-Surgeons: several physicians (usually with different specialties) working together as primary surgeons performing distinct part(s) of a procedure; claims are identified with modifier 62.

Billing requirementEach Co-Surgeon submits the same CPT code with modifier 62 on the same date of service (per coverage criteria).

Eligibility sourceProcedure eligibility for Co-Surgeon services is determined by NPFS status indicators '1' or '2' in the CMS PFS Relative Value Files.

Team Surgeons

DefinitionTeam Surgeons: three or more physicians (with different or same specialties) working together during an operative session in the management of a specific surgical procedure; claims are identified with modifier 66.

DocumentationTeam Surgeon submissions require written medical documentation describing each surgeon's specific involvement and are reviewed case-by-case.

Eligibility sourceProcedure eligibility for Team Surgeon services is determined by NPFS status indicators '1' or '2' in the CMS PFS Relative Value Files.

2024-04-14state_exception_updated

Florida state exceptions updated (modifier 62 reimbursed at 50% and modifier 66 reimburses up to 3 providers at 100% of max allowable).

2024-03-18reimbursement_guideline_revision

Policy verbiage updated in the Reimbursement Guidelines section.

2024-02-06state_exception_updated

Indiana state exceptions updated (specific CPT/HCPCS codes not covered for Indiana).

2006-01-30policy_implemented

Policy implemented by UnitedHealthcare Community & State.