Last Modified: 7/1/2025
Location: FL, PR, USVI
Business: Part A, Part B
If a team of surgeons (more than two surgeons of different specialties) is required to perform a specific procedure, each surgeon bills for the procedure with a modifier 66.
Documentation is required to support claims submitted with this modifier.
Note: The documentation should include each surgeon’s description of their role in the performance of the surgery.
Team surgeons
Under some circumstances, it’s necessary for 2 or more individual surgeons’ skills to do surgery on the same patient during the same operative session. This may happen because of the complex nature of the procedure or the patient’s condition (or both). In these cases, other providers aren’t acting as assistants-at-surgery.
• If a team of surgeons (more than 2 surgeons of different specialties) do a specific procedure, each surgeon bills the procedure using modifier 66 (Surgical team). The Medicare Fee Schedule Data Base (MFSDB) identifies certain services submitted with modifier 66. Sufficiently document the required services to show the team’s participation as reasonable and necessary. All team surgeons’ claims must contain enough information to allow pricing by report. Medicare pays the team surgery (modifier 66) on a report basis.
• If surgeons of different specialties each do a different procedure (with specific CPT codes), neither co-surgery, team surgery nor multiple surgery rules apply (even if the surgeons do the procedures through the same incision). If 1 surgeon does multiple procedures, the multiple procedure rules apply to that surgeon’s services.
• Indicator of ‘0’ - Team surgeons not permitted for this procedure.
• Indicator of ‘1’ - Team surgeons could be paid; supporting documentation required to establish medical necessity of a team; pay by report.
• Indicator of ‘2’ - Team surgeons permitted; pay by report.
• Includes other highly skilled and specially trained personnel
• Includes different types of complex equipment
• Usually confined to organ transplant teams
• Reimbursed “by report”
• Every surgeon must append modifier 66 to the CPT code.
• Modifier 66 should not be used for two or less surgeons
A kidney transplant was performed by a surgical team:
• CPT code 50365 (Renal allotransplantation, implantation of graft; with recipient nephrectomy) was billed.
• Since the kidney transplant was performed by a team of surgeons, modifier 66 is appended to the procedure code.
• CPT code 50365 has a team surgeons indicator of ‘2’, indicating team surgery is permitted.
• Each surgeon reports the same procedure code with modifier 66.
Documentation is required when the indicator on the MPFS is either a ‘1’ or ‘2’ and must provide a clinical picture of the patient and include:
• The procedures or services performed and support the use of modifier 66
• Detailed description from each surgeon outlining the role for involvement in the procedure
• The distinct part of the surgery each team surgeon performed
• The signature of each team surgeon
Claims with modifier 66 should be submitted with required documentation following the Unsolicited Paperwork (PWK) process.
• The PWK is a process allowing providers to submit documentation with an initial claim:
Claims will be rejected when reporting modifier 66 without supporting documentation.
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