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Policy No: 113

Originally Created: 09/01/2009

Section: Modifiers

Last Reviewed: 07/01/2019

Last Revised: 07/01/2019

Approved: 07/18/2019

Effective: 08/01/2019

This policy applies only to physicians and other qualified health care professionals.

Definitions

Modifier 62

Current Procedural Terminology (CPT®) - modifier 62 describes when two surgeons of same or different specialties work together as primary surgeons performing distinct part(s) of a surgical procedure.

Co-Surgeon Indicators 

The Centers for Medicare & Medicaid Services (CMS) Co-Surgeon Indicators (CO-SURG) are found in the CMS National Physician Fee Schedule Relative Value File. Values which are currently in the CMS file are:

0 - Co-surgeon not permitted for this procedure.
1 - Co-surgeons may be paid; supporting documentation required to establish medical necessity.
2 - Co-surgeons permitted; no documentation required if 2 specialty requirement met.
9 - Co-surgeon concept does not apply.

Policy statement

Our health plan will provide reimbursement for co-surgery when two surgeons share work and responsibility in performing a specific surgical procedure.

Each surgeon must bill using the same Healthcare Common Procedure Coding System (HCPCS)/CPT codes and append modifier 62. The submission of modifier 62 appended to a procedure code indicates that documentation is available in the patient's records for review upon request that will describe co-surgeons for the procedure.

Our health plan considers codes with a CMS Co-Surgeon Indicator of 1 eligible for co-surgery adjustment upon review of documentation that describes the circumstances requiring a co-surgeon. Codes with CMS Co-Surgeon indicator of 2 are eligible for co-surgery adjustment without the need for documentation.  Codes with CMS Co-Surgery Indicators of 0 and 9 should not be billed with modifier 62.

When a provider reports an eligible procedure with modifier 62 appended, reimbursement will be 125% of the allowed amount, divided equally between the co-surgeons. Each surgeon will be reimbursed 62.5% of the allowed amount. If there is more than one procedure performed, multiple surgery guidelines apply.

When a co-surgeon also acts as an assistant surgeon the additional procedures for which the surgeon assisted should be submitted with the appropriate "assistant surgeon" modifier (i.e., 80, 81, 82 or AS).

Our health plan will not reimburse for an additional assistant surgeon on a procedure where reimbursement has been provided as co-surgeons.

Our health plan will reimburse procedures when billed as either co-surgeons or as a surgeon-assistant combination.  If billing as a surgeon-assistant combination, only one surgeon may be considered the primary surgeon for that procedure. Bilateral services, even if performed simultaneously, will be reimbursed as co-surgeons (with modifiers 50 and 62 appended to both claims) or as primary surgeon and assistant surgeon. Plan will not provide reimbursement when components of a procedure are billed by more than a single primary surgeon.

References

CMS National Physician Fee Schedule Relative Value File

American Medical Association. "Appendix A: Modifiers." Current Procedural Terminology (CPT®), AMA Press

Cross References

Correct Coding Guidelines

Modifier 50; Bilateral Procedure

Modifiers 80, 81, 82, AS; Assistant at Surgery

Disclaimer

Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.