US · guidance
CMS Pub. 100-04, ch. 4, § 250.10.3
Co-surgeon Services Medicare Summary Notice (MSN) and
Remittance Advice (RA) Messages
(Rev. 3475, Issued: 03-04-16, Effective: 06-06-16, Implementation: 06-06-16)
Contractors shall deny co-surgeon services for HCPCS/CPT codes with a payment policy
indicator of ‘0’.
The contractor shall use the following remittance advice messages and associated codes
when rejecting/denying claims under this policy. This CARC/RARC combination is
compliant with CAQH CORE Business Scenario Three.
Group Code: CO
CARC: 54
RARC: N/A
MSN: 15.12
Contractors shall deny medically unnecessary co-surgeon services for HCPCS/CPT codes
with a payment policy indicator of ‘1’ when an Advance Beneficiary Notice (ABN) was
issued.
The contractor shall use the following remittance advice messages and associated codes
when rejecting/denying claims under this policy. This CARC/RARC combination is
compliant with CAQH CORE Business Scenario Three.
Group Code: PR
CARC: 54
RARC: N/A
MSN: 36.1
Contractors shall deny medically unnecessary co-surgeon services for HCPCS/CPT codes
with a payment policy indicator of ‘1’ when an Advance Beneficiary Notice (ABN) was
not issued.
The contractor shall use the following remittance advice messages and associated codes
when rejecting/denying claims under this policy. This CARC/RARC combination is
compliant with CAQH CORE Business Scenario Three.
Group Code: CO
CARC: 54
RARC: N/A
MSN: 36.2
Contractors shall deny co-surgeon services for HCPCS/CPT codes with a payment policy
indicator of ‘2’ when the co-surgeons each have the same specialty.
The contractor shall use the following remittance advice messages and associated codes
when rejecting/denying claims under this policy. This CARC/RARC combination is
compliant with CAQH CORE Business Scenario Three.
Group Code: CO
CARC: 54
RARC: N/A
MSN: 21.21
Contractors shall deny line items for co-surgeon services without the 62 modifier on
claims with the same surgical procedure code and line item date of service on more than
one line when only one line has the 62 modifier.
The contractor shall use the following remittance advice messages and associated codes
when rejecting/denying claims under this policy. This CARC/RARC combination is
compliant with CAQH CORE Business Scenario Two.
Group Code: CO
CARC: 4
RARC: N/A
MSN: 16.10
History
(Rev. 3475, Issued: 03-04-16, Effective: 06-06-16, Implementation: 06-06-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
0a33d25f8b3c6b55b95909ed4725e8b5a85d7e351b64682ba4c6d3783a7e4c77
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