Description:
Two surgeons
Guidelines/Instructions:
Refer to the Medicare Physician Fee Schedule database (MPFSDB) to determine if CPT modifier 62 is applicable to a particular surgical CPT code.
The following documentation is required with the claim for procedures with Co-Surg Indicator 1 only:
- For electronic claims, submit an operative report via the fax attachment process. Railroad Medicare does not have a fax process.
- For paper claims, submit the operative report as an attachment to the CMS-1500 claim form
- Follow the steps below to identify the Co-Surg Indicator
Steps:
- Access the database directly from the CMS Web site at www.cms.hhs.gov/PFSlookup/
- Select Physician Fee Schedule Search from the left area of the Web page
- Screen defaults to current year. Under Type of Information, select Payment Policy Indicators, then 'next'
- On the 'select field options' screen, select 'Next'
- Enter the procedure code and select 'All Modifiers', then click 'Submit'
- Refer to the column heading 'Co Surg'
- Indicator 0: Cosurgeons are not permitted for this procedure
- Indicator 1: Cosurgeons could be paid; supporting documentation is required with the claim to establish the medical necessity of two surgeons for the procedure
- Indicator 2: Cosurgeons permitted; no documentation required if the surgeons are of two different specialties
- Indicator 9: Concept does not apply. This indicator often appears in the Co Surg column for non-surgical procedures.
Reference:
last updated on 12/01/2009