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CPT Modifier 66
Description:
Surgical team
Guidelines/Instructions:
Refer to the Medicare Physician Fee Schedule database (MPFSDB) to determine if CPT modifier 66 is applicable to a particular surgical CPT code. Note that team surgeries are normally limited to organ transplants and re-transplants.
Documentation required with the claim:
- For electronic claims, submit an operative report via the fax attachment process. Railroad Medicare does not have a fax attachment process.
- For paper claims, submit the operative report as an attachment to the CMS-1500 claim form
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 'Team Surg'
- Indicator 0: Team surgeons are not permitted for this procedure
- Indicator 1: Team surgeons could be paid; supporting documentation is required with the claim to establish the medical necessity of a team. An operative report must be submitted with the claim.
- Indicator 2: Team surgeons permitted. An operative report must be submitted with the claim
- Indicator 9: Concept does not apply (i.e., the procedure is not surgical)
Reference: