For Providers

Reimbursement Policies & Guidelines

Text Size

Co-Surgeon Modifier 62

Effective Date: May 10, 2016

Purpose:
To implement the appropriate reimbursement for the modifier 62 surgical procedures according to CMS guidelines which can aid in future cost avoidance.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

Scope:
All products are included, except

  • Products where Horizon NJ Health is secondary to Medicare (e.g. Medigap).
  • COB

Policy:
Co-surgery refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously. If two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon should bill for the procedure with a modifier “-62.” For co-surgeons (modifier 62), the fee schedule amount applicable to the payment for each co-surgeon is 62.5 percent of the global surgery fee schedule amount.

The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. In the event of such changes, the Policy will continue to be in force, albeit applied to the new or amended coding so issued until such time as the Policy is reviewed and updated to reflect the new or amended coding.

Procedure:
For co-surgeons (modifier 62) surgical procedures, the fee schedule amount applicable to the payment for each co-surgeon is 62.5 percent of the global surgery fee schedule amount.

Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:

  • Group or Individual benefit
  • Provider Participation Agreement
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
  • Mandated or legislative required criteria will always supersede.