Modifier 62- Two Surgeons

Identifies a procedure in which two surgeons work together as primary surgeons, each performing a distinct part of the same reportable surgical procedure.

What Is Modifier 62?

Modifier 62 identifies co-surgery involving two surgeons who work together as primary surgeons during the same surgical procedure.

Under Medicare rules, co-surgery generally applies when two surgeons, each in a different specialty, are required to perform distinct portions of a single reportable procedure. Each surgeon reports the same procedure code with Modifier 62.

The modifier does not simply indicate that two physicians were present during surgery. Both surgeons must function as primary surgeons and perform distinct operative work associated with the same procedure.

Medicare uses the Physician Fee Schedule co-surgeon indicator to determine whether a particular procedure is eligible for co-surgeon payment.

When to Use Modifier 62

Two Primary Surgeons: Two surgeons work together as primary surgeons during the procedure.

Distinct Operative Work: Each surgeon performs a distinct portion of the same reportable surgical procedure.

Same Procedure Code: Both surgeons report the same qualifying procedure code with Modifier 62.

Different Specialties: Medicare co-surgery rules generally require surgeons of different specialties when two surgeons are necessary for the procedure.

Procedure Allows Co-Surgeons: The Medicare Physician Fee Schedule co-surgeon indicator supports co-surgeon payment.

Medical Necessity Supported: When required, documentation establishes why the skills of two surgeons were medically necessary.

When NOT to Use Modifier 62

One Surgeon Is Assisting: If one physician serves only as an assistant rather than a primary co-surgeon, an applicable assistant-at-surgery modifier such as 80 may be appropriate instead.

Surgeons Perform Different Procedures: If surgeons of different specialties each perform separate procedures represented by different CPT codes, Medicare states that co-surgery rules generally do not apply.

More Than Two Surgeons: Modifier 66 may apply when a qualifying team of more than two surgeons of different specialties is required.

Procedure Does Not Allow Co-Surgeons: Do not use Modifier 62 when the Medicare Physician Fee Schedule indicates that co-surgeon payment is not permitted.

Same Work Reported Twice: Both surgeons should not independently report work as co-surgery unless each performed a distinct portion of the qualifying procedure.

Billing Example

A complex surgical procedure requires the expertise of two surgeons from different specialties.

Both physicians serve as primary surgeons. One surgeon performs one distinct portion of the procedure, while the second surgeon performs another portion of the same reportable procedure.

Each surgeon reports the same CPT procedure code with Modifier 62.

Their operative documentation should clearly describe the distinct work each surgeon performed and, when required, establish the medical necessity for having two primary surgeons.

Documentation Requirements

Role of Each Surgeon: Clearly establish that both physicians functioned as primary surgeons.

Distinct Operative Work: Each operative report should describe the specific portion of the procedure performed by that surgeon.

Medical Necessity: When required by the Medicare co-surgeon indicator, explain why two surgeons were medically necessary.

Procedure Performed: Documentation should support the same surgical procedure code reported by both surgeons.

Specialties: Document the respective specialties and expertise involved when relevant to the co-surgery requirements.

Operative Report: Maintain complete operative documentation supporting the services reported by each surgeon.

Billing and Claim Considerations

Before reporting Modifier 62, check the procedure's Co-Surgeon indicator in the Medicare Physician Fee Schedule.

CMS currently defines the indicators as:

0: Co-surgeons are not allowed for the procedure.

1: Co-surgeons may be paid, but supporting documentation must establish the medical necessity for two surgeons.

2: Co-surgeons are allowed, and additional documentation is not required when the two-specialty requirement is met.

9: The co-surgeon concept does not apply.

When Medicare's co-surgery requirements are satisfied, each co-surgeon is generally paid 62.5% of the applicable global surgery fee schedule amount.

This results in a combined allowance of 125% when both qualifying co-surgeons are paid.

Common Billing Mistakes

Only One Surgeon Reports Modifier 62: When two physicians are acting as co-surgeons, each should report the qualifying procedure with Modifier 62.

Confusing Co-Surgery With Assistance: An assistant surgeon supports the primary surgeon; a co-surgeon performs a distinct portion of the procedure as another primary surgeon.

Different Procedures Reported as Co-Surgery: Separate procedures represented by different CPT codes generally do not constitute co-surgery merely because they occur during the same operative session.

Ignoring the PFS Indicator: Not every surgical procedure qualifies for Medicare co-surgeon payment.

Insufficient Documentation: The operative record does not distinguish the work performed by each surgeon.

Assuming Two Surgeons Automatically Qualify: The presence of two surgeons does not by itself establish co-surgery.

Common Denial Reasons

Co-Surgeons Not Allowed: The procedure has a Medicare co-surgeon indicator of 0.

Medical Necessity Not Established: A procedure with indicator 1 lacks sufficient documentation supporting the need for two surgeons.

Modifier Missing From One Claim: The corresponding surgeon's claim does not properly identify the co-surgery arrangement.

Roles Not Supported: Documentation does not establish that both physicians acted as primary surgeons.

Separate Procedures Performed: The surgeons actually performed independently reportable procedures rather than distinct portions of one procedure.

Operative Documentation Insufficient: The records do not clearly identify each surgeon's distinct operative work.

Modifier 62 vs. Modifier 80

Modifier 62: Two surgeons work together as primary surgeons and perform distinct portions of the same reportable procedure.

Modifier 80: An assistant surgeon assists the primary surgeon during a procedure.

The key distinction is the physician's role. A co-surgeon is another primary surgeon; an assistant surgeon supports the primary surgeon rather than independently performing a distinct primary portion.

Modifier 62 vs. Modifier 66

Modifier 62: Identifies qualifying co-surgery involving two surgeons.

Modifier 66: Identifies a qualifying surgical team involving more than two surgeons of different specialties.

Medicare evaluates team surgery separately and pays qualifying Modifier 66 services by report.

Frequently Asked Questions

Do both surgeons report Modifier 62?
Yes. When Medicare co-surgery requirements are met, each surgeon reports the same qualifying surgical procedure code with Modifier 62.

How do I know whether Medicare allows Modifier 62 for a procedure?
Check the procedure's Co-Surgeon indicator in the Medicare Physician Fee Schedule. The indicator identifies whether co-surgery is prohibited, potentially payable with supporting documentation, allowed, or not applicable.