US · guidance
CMS Pub. 100-04, ch. 12, § 40.9
Procedures Billed With Two or More Surgical Modifiers
B3-4829
A/B MACs (B) may receive claims for surgical procedures with more than one surgical
modifier. For example, since the global fee concept applies to all major surgeries, A/B MACs
(B) may receive a claim for surgical care only (modifier “-54”) for a bilateral surgery (modifier
“-50”). They may also receive a claim for multiple surgeries requiring the use of an assistant
surgeon.
Following is a list of possible combinations of surgical modifiers.
(NOTE: A/B MACs (B) must price all claims for surgical teams “by report.”)
• Bilateral surgery (“-50”) and multiple surgery (“-51”).
• Bilateral surgery (“-50”) and surgical care only (“-54”).
• Bilateral surgery (“-50”) and postoperative care only ("55”).
• Bilateral surgery (“-50”) and two surgeons (“-62”).
• Bilateral surgery (“-50”) and surgical team (“-66”).
• Bilateral surgery (“-50”) and assistant surgeon (“-80”).
• Bilateral surgery (“-50”), two surgeons (“-62”), and surgical care only (“-54”).
• Bilateral surgery (“-50”), team surgery (“-66”), and surgical care only (“-54”).
• Multiple surgery (“-51”) and surgical care only (“-54”).
• Multiple surgery (“-51”) and postoperative care only ("55”).
• Multiple surgery (“-51”) and two surgeons (“-62”).
• Multiple surgery (“-51”) and surgical team (“-66”).
• Multiple surgery (“-51”) and assistant surgeon (“-80”).
• Multiple surgery (“-51”), two surgeons (“-62”), and surgical care only (“-54”).
• Multiple surgery (“-51”), team surgery (“-66”), and surgical care only (“-54”).
• Two surgeons (“-62”) and surgical care only (“-54”).
• Two surgeons (“-62”) and postoperative care only (“55”).
• Surgical team (“-66”) and surgical care only (“-54”).
• Surgical team (“-66”) and postoperative care only (“55”).
Payment is not generally allowed for an assistant surgeon when payment for either two
surgeons (modifier “-62”) or team surgeons (modifier “-66”) is appropriate. If A/B MACs (B)
receive a bill for an assistant surgeon following payment for co-surgeons or team surgeons,
they pay for the assistant only if a review of the claim verifies medical necessity.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
42770dc0a6397c5f5896d52b9dc8ef2fa2a2e3db57d75328f1b268c4304920a0
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