Commercial reimbursement policy update to Modifier 66: Surgical Teams (Professional)

In the December 2021 edition of Provider News, we announced that a new commercial reimbursement policy titled Modifier 66 Surgical Teams – Professional would be effective for dates of service on or after March 1, 2022. The effective date of the policy has changed. The policy will now be effective for dates of service on or after November 1, 2022.

 

Modifier 66: Surgical Teams — Professional: Under this reimbursement policy, Anthem Blue Cross and Blue Shield (Anthem) allows the use of procedures eligible for surgical teams when billed with modifier 66.

 

Anthem follows the Centers for Medicaid and Medicare Services (CMS) Medicare physician fee schedule (MPFS) team surgery payment indicators and will allow services requiring team surgery billed with CMS MPFS payment indicator 1 (sometimes) and 2 (always) and will deny services billed with the indicator 0 (never) and 9 (not applicable).

 

For specific policy details, visit our reimbursement policy page, at anthem.com/provider.

 

 

MULTI-BCBS-CM-004854-22-CPN4828