Co-surgery Modifier Enforcement

  • May 7, 2020

    When two surgeons of the same or different specialty work together as primary surgeons on the same procedure, each reports their own distinctive part and both providers bill the same surgical procedure code appended with modifier 62. This indicates they acted as co-surgeons.

    Starting with claims processed on and after August 6, 2020, when two surgeons perform distinct parts of the same procedure, bilateral or not, Premera will no longer reimburse these independent procedures unless submitted procedures are appended with a co-surgeon modifier.

    Premera uses the co-surgeon indicator flag in the current CMS National Physician Fee Schedule to determine whether co-surgeons are applicable for a specific procedure.

    Review the criteria for the use of modifier 62 in the current payment policy.

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