CPT Modifier 66
Guidelines and 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
- For paper claims, submit the operative report as an attachment to the CMS-1500 claim form
- Access the database 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")
- 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)