Can modifier 62 and 22 be billed together?
Asked by: German Steuber I | Last update: May 9, 2025Score: 4.8/5 (17 votes)
What is the CMS policy for modifier 62?
Codes with CMS Co-Surgery Indicators of 0 and 9 should not be billed with modifier 62. When a provider reports an eligible procedure with modifier 62 appended, reimbursement will be 125% of the allowed amount, divided equally between the co-surgeons. Each surgeon will be reimbursed 62.5% of the allowed amount.
What is the CMS guideline for modifier 22?
Modifier -22 can only be used on one procedure code, per member, per date of service. D. In order to be considered for additional reimbursement, modifier -22 may only be reported with a valid procedure code that has a global period of 0, 10, or 90 days on the Medicare Physician Fee Schedule (MPFS).
When using modifier 62 which would be the correct use?
To bill for co-surgery, both surgeons must bill using the same CPT® code(s) and append modifier 62. In other words, you should append modifier 62 when two surgeons work together to complete a procedure described by a single CPT® procedure code.
Can you bill a co-surgeon and an assistant surgeon for the same procedure?
modifier 62 listed in the first position. NOTE: Physicians cannot bill as assistants for the procedure in which they acted as co-surgeons. When two surgeons are operating on two completely different anatomic portions of the patient on the same date and time, it is not considered co-surgery.
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Can an assistant surgeon use modifier 22?
Assistant surgery services may be submitted with the modifier -22 as secondary to the appropriate surgical assist modifier (-81, 82 or –AS) for surgical procedures that are difficult, complex or complicated or situations where the service necessitated significantly more time to complete than the typical work effort.
What is the appropriate modifier to use when two surgeons perform?
62 Co-Surgeon/Two Surgeons: When 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work ...
How do I bill a modifier 62?
Medical Necessity Drives Use of Modifier 62
Medicare requires documentation that the procedure (or the patient's condition) was of a nature that two surgeons of different specialties were medically necessary. This is identified in Medicare Physician Fee Schedule by an indicator next to the procedure code of 0, 1 or 2.
What is an example of a 62 modifier?
Example 1 (appropriate use of modifier code 62)
One surgeon performs the endoscopy. The other surgeon makes an incision into the abdomen and inserts the gastrostomy tube. The surgery is appropriate for co-surgery. Both surgeons should bill using the same CPT procedure code (43246) and modifier code 62.
Can you bill modifier 62 and 80 together?
Answer: Yes. When billing for an assistant-at surgery, modifier -80, payment for the assistant is at 16 percent of the allowable. When two surgeons perform key portions of the same surgery and billing with modifier -62, payment is 62.5 percent of the allowable to each surgeon.
How do you add modifier 22?
As per the Centers for Medicare and Medicaid Services (CMS), the correct use of modifier 22 applies mainly to surgeries for which work performed is significantly greater than usually required. Modifier 22 is appended to the CPT code of a primary or secondary procedure of a multiple procedure claims.
When surgery is performed, what services are included and not billed separately?
With few exceptions, the payment for a surgical procedure includes payment for dressings, supplies, and local anesthesia. These items are not separately reportable under their own HCPCS/CPT codes.
How to bill for multiple procedures?
Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. It applies to: Different procedures performed at the same session. A single procedure performed multiple times at different sites.
How much more does Medicare pay for modifier 22?
Among accepted claims, those with modifier 22 had increased payments ranging from 0.8% (95% CI, 0.7-1.0) to 4.8% (95% CI, 4.5-5.1). However, claims with modifier 22 were more likely to be denied (7.4% vs 4.0%; P < . 001).
What modifier must always be applied to Medicare claims?
Rationale: Medicare requires that the QW modifier be applied for all claims for payment of test performed in a site with a CLIA waived certificate. If the location does not have a certificate, the service should not be billed and it should not be performed.
Is a surgical assistant a doctor?
Most surgical assistants are trainee surgeons or junior doctors, but In the United Kingdom, a surgical care practitioner, who is not a qualified doctor, may perform simple surgical operations under the supervision of one.
What is the CMS policy on modifier 62?
As stated in 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 the 62 modifier (two surgeons) for co- surgeon services. Each co-surgeon reports the same surgical procedure code with the 62 modifier.
When using modifier 62 which would be the correct use of the code?
If the two surgeons (each a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier 62.
Why would a TC be billed and not PC?
Modifier TC is used when only the technical component (TC) of a procedure is being billed when certain services combine both the professional and technical portions in one procedure code. Use modifier TC when the physician performs the test but does not do the interpretation.
Is modifier 22 a payment modifier?
Physical and mental effort required. Modifier 22 is a pricing modifier and should be reported in the first position.
How do you bill with modifiers?
You enter the pricing modifier directly to the right of the procedure code on the claim. Most providers use the electronic equivalent of this form to bill Medicare for professional (pro-fee) services.
Can you bill a co-surgeon in the same specialty?
A: Yes. To be considered for reimbursement, documentation is required supporting the Co-Surgeons working as the primary surgeon performing a distinct part or parts of the same procedure.
What are the rules for modifier 62?
(1) If two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier “-62.” Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously, i.e., heart transplant or bilateral ...
What is the two digit modifier that indicates two primary surgeons?
Identifies a surgical procedure that requires two surgeons that perform on distinct parts of a procedure. Note: Each surgeon would bill with modifier 62. For use with surgery codes: 66820, 66821, 66830, 66840, 66850, 66920, 66930, 66940 and 66982 through 66985. Requires “By Report” documentation.
What is the difference between modifier 52 and 22?
Modifier 52 is used to indicate that a procedure was partially reduced, eliminated, or discontinued at the physician's discretion, while Modifier 22 is used to indicate that a procedure was more difficult or complex than usual and required significant additional time and effort.