Two Surgeons (CPT Modifier 62)
For co -surgeons, we will continue the current predominant carrier practice of paying 125 percent of the global fee and dividing the payment equally between the two surgeons. No payment will be made for an assistant at surgery in these cases. Each surgeon needs to file with the 62 modifier and documentation of his/her co ntribution to the procedure. If one surgeon files with no modifier and you file with the 62 modifier, then you will receive a denial for documentation. We will contact the other surgeon to refund the overpayment and add the 62 modifier to his/her claim.
Example: Here is an example of the pricing. The fee schedule amount allowed is $1908.48, multiplied by 125%, then split between the two surgeons. Code 4855462 would allow $1192.80 for each surgeon.
Surgical Team (CPT Modifier 66)
We will continue to allow our Carrier Medical Directors (CMDs) to determine the payment amounts for team surgery on an individual basis. Each doctor on the team must file hard copy with documentation of his/her unique contribution to the procedure and each physician ’ s claim will be manually priced based on those records.
