What is modifier 62 used for?
Asked by: Stephania Gorczany | Last update: September 18, 2025Score: 4.5/5 (73 votes)
When should modifier 62 be used?
Reminder: Modifier 62 indicates that the services of two or more surgeons were required for the same procedure(s), during the same operative session, on the same patient, on the same date of service.
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.
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.
What is the difference between 62 and 80 modifier?
Thus, if a surgery requires co-surgeons, both practitioners must append the modifier 62 to bill for the whole procedure. In contrast, healthcare providers should use modifier 80 if the second healthcare provider acted as an assistant.
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What is modifier 80 used for?
Current Procedural Terminology (CPT®) Modifier 80 - CPT Modifier 80 represents assistant at surgery by another physician. This assistant at surgery is providing full assistance to the primary surgeon.
How much does modifier 62 pay?
If the surgery is billed with a “-62” modifier and the Co-Surgeons column contains an indicator of “2,” payment rules for two surgeons apply. The claims administrator shall base payment for each physician on the lower of the billed amount or 62.5 percent of the fee schedule amount.
What is an example of a 79 modifier?
Modifier 79 Example #2
A physician performs exploratory surgery on a lump discovered in a patient's forearm. The lump turns out to be a benign cyst. Within the post-op period, the same patient returns to have a fibroma removed by the same physician. The two incidents are unrelated, so modifier 79 is used.
How do you use modifier 82?
Append modifier 82 to a procedure code for an assistant surgeon when he assists an operating, or principal, surgeon during an entire procedure because a medical resident was unavailable to assist.
Does Medicare pay for a co-surgeon?
Payment for each co-surgeon is based on the lesser of the actual charges or 62.5% of the Medicare Physician Fee Schedule (MPFS) amount. For both surgeons to receive appropriate reimbursement, they must not be assisting each other, but performing distinct and separate parts of the same surgical procedure.
How do I know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).
Can you bill for more than one assistant surgeon?
However, only one assistant per operative session will be reimbursed. Claims for services of an assistant surgeon should be filed with modifier 80, 81, 82 or AS. Use of modifiers is required for proper payment.
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.
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.
What is unusual anesthesia?
Unusual anesthesia - Used to report a procedure which usually requires either no anesthesia or local anesthesia; however, because of unusual circumstances must be done under general anesthesia.
How do you know if a code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
When to use modifier 62?
Two surgeons. Under some circumstances, the individual skills of two or more surgeons 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.
When to use modifier 90?
Independent laboratories shall use modifier 90 to identify all referred laboratory services. A claim for a referred laboratory service that does not contain the modifier 90 is returned as unprocessable if the claim can otherwise be identified as being for a referred service.
What is the 59 modifier used for?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
What is modifier 73 used for?
Modifier -73 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated due to extenuating circumstances or to circumstances that threatened the well being of the patient after the patient had been prepared for the procedure (including procedural pre-medication when ...
What is modifier 57?
Modifier 57 is used to indicate an Evaluation and Management (E/M) service resulted in the initial decision to perform surgery either the day before a major surgery (90 day global) or the day of a major surgery.
What is the difference between modifier 62 and 80?
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.
What is modifier 63?
The purpose of the -63 modifier is to support additional reimbursement to reflect the increased complexity and physician work commonly associated with procedures for infants up to a present body weight of 4 kg. Modifier -63 is to be appended to procedures performed on neonates and infants up to a body weight of 4 kg.
What is modifier 60?
The CPT manual introduced modifier -60 in 2001 to allow providers to indicate when a procedure was more complex than normal due to an altered surgical field.