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.
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 (MPFSDB) indicator descriptions:
Indicator of 1 - supporting documentation is required to establish medical necessity of two surgeons for the procedure
Indicator of 2 - the payment rule for two surgeons applies
Both surgeons must agree to append modifier 62 on their claim
Reimbursement is made at 62.5% of MPFS
Indicator in MPFS must be either 1 or 2
Procedure code and diagnosis code should be same
Billed amount may differ
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 the 62 modifier will pay at 100%
The other physician's claim without the 62 modifier will deny
Each surgeon billing without modifier 62 will result in incorrect payment
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:
Date of service |
Procedure code/modifier |
Charge |
Units |
11/05/20XX |
22554/62 |
$1350.00 |
1 |
Surgeon B bills as follows
Date of service |
Procedure code/modifier |
Charge |
Units |
11/05/20XX |
22554/62 |
$1300.00 |
1 |
Payment is 62.5% of the allowable for code 22554 for both surgeons. If the allowance for CPT code 22554 is $1272.44, each surgeon will get 62.5% or $795.28.
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 62
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
When the MPFS indicator is a '2', 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:
Ensure two specialty requirements include NPI of the rendering physician
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:
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.
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