CMS Pub. 100-04, ch. 4, § 250.10

Under some circumstances, the skills of two surgeons (each in a different specialty) 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.

Co-surgery refers to a single surgical procedure which requires the skill of two surgeons,

each in a different specialty, performing parts of the same procedure simultaneously. It is

not always co-surgery when two doctors perform surgery on the same patient during the

same operative session. Co-surgery has been performed if the procedure(s) performed is

part of and would be billed under a single surgical procedure code.

When two surgeons work together as primary surgeons performing distinct part(s) of a

single reportable procedure, each surgeon shall report his/her distinct operative work by

reporting the same surgical procedure code and the 62 modifier (two surgeons).

The potential exists that there may only be one line billed on a Method II CAH claim

with modifier 62. This occurs when one of the co-surgeons reassigns their billing rights

to the CAH and the other co-surgeon does not reassign their billing rights to the CAH.

The claim for the co-surgeon that reassigned their billing rights would be processed by

the A/B MAC (A). The claim for the co-surgeon that did not reassign their billing rights

to the CAH would be processed by the A/B MAC (B). The A/B MAC (A) standard

system (FISS) will accept and process claims with one line with a surgical procedure

code and modifier 62 or two lines with the same surgical procedure code, line item date

of service (LIDOS) and modifier 62. The FISS shall deny line items without the 62

modifier on claims with the same surgical procedure code and LIDOS when only one line

has the 62 modifier.

Co-surgeon services rendered by a physician that has reassigned their billing rights to a

Method II CAH are payable by Medicare when the procedure is authorized for co-surgeons and is billed on type of bill 85X with revenue code (RC) 96X, 97X or 98X and

the 62 modifier.

Under authority of 42 CFR 414.40, CMS establishes uniform national definitions of

services, codes to represent services, and payment modifiers to the codes. This includes

the use of payment modifiers for co-surgeon services.