Modifier 60- Altered Surgical Field

Modifier 60 historically identified procedures performed in a significantly altered surgical field, but Medicare does not recognize it for payment and directs providers to use Modifier 22 when increased procedural work is supported.

What Is Modifier 60?

Modifier 60 was introduced to identify procedures involving significantly increased operative complexity or time because surgery was performed in a substantially altered surgical field.

Examples historically associated with an altered surgical field included prior surgery, marked scarring, adhesions, inflammation, or distorted anatomy that made the procedure significantly more difficult than normally expected.

However, Medicare does not recognize Modifier 60 for payment purposes.

CMS determined that Modifier 22 — Increased Procedural Services — was sufficient for reporting procedures requiring substantially greater work than normally required. CMS therefore instructed physicians to continue using Modifier 22 rather than Modifier 60 when unusual operative circumstances justify consideration of additional payment.

When Modifier 60 Was Intended to Be Used

Altered Surgical Field: The operative field was substantially changed by previous treatment, disease, or other circumstances.

Prior Surgery: Previous procedures resulted in significant changes to the anatomy or operative field.

Extensive Scarring: Marked scar tissue substantially increased the complexity of the procedure.

Significant Adhesions: Adhesions made the procedure considerably more difficult or time-consuming than normally expected.

Inflammation: Significant inflammatory changes altered the operative field and increased procedural complexity.

Distorted Anatomy: Anatomical changes substantially increased the difficulty of performing the procedure.

These circumstances describe the historical purpose of Modifier 60. They do not mean Modifier 60 should be submitted on current Medicare claims.

When NOT to Use Modifier 60

Medicare Claims: Medicare does not recognize Modifier 60 for payment. CMS directed physicians to use Modifier 22 when appropriate.

Routine Surgical Difficulty: A procedure being somewhat difficult does not automatically support increased procedural service reporting.

Expected Complexity: Additional work already reflected in the procedure's code and valuation should not be separately represented as unusual procedural work.

Insufficient Documentation: Increased complexity should not be reported when the operative documentation does not demonstrate substantially greater work.

Current Modifier 22 Applies: When substantially increased procedural services satisfy current requirements, Modifier 22 is the relevant modifier to evaluate rather than Modifier 60.

Billing Example

A surgeon performs a procedure in an operative field substantially altered by previous surgery and extensive adhesions.

Removing the adhesions and safely identifying anatomical structures requires significantly greater time and technical work than ordinarily required for the procedure.

Historically, these circumstances represented the type of altered surgical field associated with Modifier 60.

For Medicare billing, however, the surgeon should not report Modifier 60. When the additional work satisfies Medicare requirements, the procedure may instead be reported with Modifier 22 and appropriate supporting documentation.

Documentation Requirements

Operative Report: Document the procedure and circumstances that created the unusual complexity.

Altered Anatomy: Describe scarring, adhesions, inflammation, distorted anatomy, or other relevant findings.

Additional Work: Explain specifically how the circumstances increased the work required to perform the procedure.

Additional Time: Document substantial additional operative time when relevant.

Comparison to Typical Procedure: The record should make clear why the work exceeded what is normally required for the reported procedure.

Modifier 22 Support: For current Medicare reporting, documentation should support the requirements for Modifier 22 rather than Modifier 60.

Billing and Claim Considerations

Modifier 60 should not be treated as a current Medicare payment modifier.

When CMS reviewed Modifier 60, it concluded that recognizing the modifier could lead to routine reporting for circumstances already reflected in procedure valuations and create substantial manual-review requirements.

CMS instead retained Modifier 22 as the mechanism for identifying unusually extensive procedural work.

Current Medicare Claims Processing Manual guidance continues to instruct providers to use Modifier 22 when surgical services performed are significantly greater than normally required. Medicare requires supporting information describing how the service differed from the usual procedure along with the operative report.

Providers dealing with a non-Medicare payer should verify that payer's current modifier policies rather than assuming Modifier 60 is accepted.

Common Billing Mistakes

Treating Modifier 60 as Active for Medicare: CMS does not recognize Modifier 60 for Medicare payment.

Using 60 Instead of 22: Substantially increased procedural work should be evaluated under current Modifier 22 requirements.

Reporting Expected Complexity: Additional work already inherent in the procedure should not automatically support increased-service reporting.

Insufficient Operative Documentation: Simply stating that surgery was difficult does not establish substantially increased procedural work.

Assuming an Altered Field Guarantees Additional Payment: The documentation must demonstrate how the circumstances materially increased the work required.

Ignoring Payer-Specific Rules: Non-Medicare payer requirements should be verified before submitting any modifier.

Common Denial Reasons

Modifier Not Recognized: Medicare does not recognize Modifier 60 for payment.

Incorrect Modifier Selection: Modifier 22 or another current modifier is appropriate for the documented circumstances.

Additional Work Not Supported: Documentation does not demonstrate substantially greater procedural work.

Complexity Already Included: The additional difficulty is considered inherent in the procedure being reported.

Insufficient Documentation: The operative report does not adequately explain the unusual circumstances.

Payer Policy Not Met: The modifier does not satisfy the payer's current coding requirements.

Modifier 60 vs. Modifier 22

Modifier 60: Historically described procedures performed in a significantly altered surgical field.

Modifier 22: Identifies increased procedural services when the work required is substantially greater than typically required.

For Medicare, Modifier 22 is the relevant current modifier. CMS specifically determined that Modifier 22 was sufficient for unusual procedural circumstances and declined to recognize Modifier 60 for payment.

Frequently Asked Questions

Is Modifier 60 recognized by Medicare?
No. CMS declined to recognize Modifier 60 for Medicare payment and instructed physicians to continue using Modifier 22 when unusual procedural circumstances support increased services.

What should be used instead of Modifier 60 for Medicare?
Modifier 22 should be considered when a procedure requires substantially greater work than normally required and the operative documentation supports the increased procedural services.