Effective Date:
May 10, 2016

Last Revised:
April 26, 2020

Purpose:
To provide guidelines of reimbursement for use of modifier -62 with surgical procedures according to CMS guidelines.

Scope:
Products included:

• NJ FamilyCare/Medicaid
• FIDE-SNP

Definitions:

• Modifier -62 (Two Surgeons): When two (2) surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier -62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the co-surgery once using the same procedure code. If additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier -62 added.

Note: If a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier -62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier -80 or modifier -82 added, as appropriate.

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:

• Benefit Limitations
• The terms of any applicable provider participation agreement;
• Routine claim editing logic, including but not limited to incidental or mutually exclusive logic;
• Medical necessity; and
• Applicable law, regulatory guidance, government mandates, and the terms of the Managed Care Contract between Horizon NJ Health and the New Jersey Department of Human Services, Division of Medical Assistance and Health Services.

References:
Medicare Claims Processing Manual (Pub.100-04). Chapter 12

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

American Medical Association, Current Procedural Terminology (CPT®) Professional Edition and associated publications and services

History: