The individual skills of two surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient's condition and the additional physician is not acting as an assistant at surgery.

If the two surgeons (each a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier 62.

Guidance

Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously (e.g., heart transplant or bilateral knee replacements).

When billing the surgical procedure with modifier 62, documentation of the medical necessity for two surgeons is required for certain services identified in the Medicare Physician Fee Schedule Database (MPFSDB) Indicator List:

• Indicator of 1 -- supporting documentation is required to establish medical necessity of two surgeons for the procedure
• Indicator of 2 -- payment rule for two surgeons applies

Correct use

• Both surgeons must agree to append modifier 62 on their claim
  • Reimbursement is made at 62.5% of MPFSDB
  • Indicator in MPFSDB must be either 1 or 2
• Procedure code and diagnosis code should be same
• Billed amount may differ

Incorrect use

• Modifier 62 should not be used when a surgeon acts as an assistant surgeon
• Reporting modifier 62 on only one of the surgeons' claims
  • The claim with modifier 62 will pay at 100%
  • The other physician's claim without modifier 62 will deny
• Each surgeon billing without modifier 62 will result in incorrect payment

Claim coding example

Two surgeons are co-surgeons on an arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2 (CPT code 22554).

Surgeon A bills as follows:

Surgeon B bills as follows:

Payment is 62.5% of the allowable amount for CPT code 22554 for both surgeons. If the allowance for CPT code 22554 is $1272.44, each surgeon will get 62.5% or $795.28.

Supporting documentation

Documentation is required when the indicator on the MPFS is a ‘1’ and must provide a clinical picture of the patient and include: 

• The procedures or services performed and support the use of modifier 66
• The name of the co-surgeon
• The necessity of the co-surgeon
• The signature of at least one surgeon
• The distinct part of the surgery each co-surgeon performed
• Ensure two specialty requirements include NPI of the rendering physician:
  • No documentation is needed if the two-specialty requirement is met. If the requirements are not met, include documentation for each surgeon substantiating medical necessity.

Claims with modifier 62 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:
  • Detailed information is outlined in Submitting Unsolicited Paperwork (PWK) Segments for Electronic Claims

Claims will be rejected when reporting modifier 62 without supporting documentation. Rejected claims will need to be resubmitted using the instructions above for submitting documentation with your initial claim.

References

• CMS IOM Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 40.8
• Global Surgery MLN Booklet
• Global Surgery
• Medicare physician fee schedule payment policy indicators
• Transcatheter Aortic Valve Replacement Claim Submission