Description
Two surgeons.

Guidelines/Instructions
Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient’s condition. In these cases, the additional physicians are not acting as assistants-at-surgery.

If two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a CPT modifier 62 (Two Surgeons). Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously, i.e., heart transplant. Documentation of the medical necessity for two surgeons is required for certain services identified in the Medicare Fee Schedule Data Base (MFSDB)*.

Refer to the Medicare Physician Fee Schedule database (MPFSDB) to determine if CPT modifier 62 is applicable to a particular surgical CPT code.

Follow the steps below to identify the Co-Surgical Indicator:

  • Access the Medicare Physician Fee Schedule Database (MPFSDB) directly from the CMS website
    • Select Physician Fee Schedule Search from the bottom of the web page
    • Screen defaults to current year. Under Type of Information, select Payment Policy Indicators.
    • Choose a single procedure code, multiple procedure codes or a range of codes, then enter the appropriate code(s)
    • Select modifier (or select "all modifiers")
    • 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 (*see note below)
  • 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. 

*Note: An operative report must be submitted with CPT modifier 62 for procedures with "Co-Surg" Indicator of 1.

References:

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department


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