New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams - professional

Beginning with dates of service on or after March 1, 2022, Empire BlueCross BlueShield’s (“Empire”) Co-Surgeon/Team Surgeon Services commercial reimbursement policy will be retired and replaced with the following reimbursement policies:

• Modifier 62: Co-Surgeon Services – professional: Under this reimbursement policy, Empire allows reimbursement of procedures eligible for co-surgeons when billed with modifier 62. Empire follows the Centers for Medicare & Medicaid Services (CMS) Medicare Physician Fee Schedule (MPFS) Co-Surgery payment indicators and will allow services requiring a co-surgeon billed with CMS MPFS payment indicator ‘2’ (always) and will deny services billed with indicator ‘0’ (never), ‘1’ (sometimes) and ‘9’ (not applicable). Reimbursement for each surgeon is based on 63 percent of the applicable fee schedule or contracted/negotiated rate.

 

• Modifier 66: Surgical Teams – professional: Under this reimbursement policy, Empire allows the of procedures eligible for surgical teams when billed with modifier 66. Empire follows the CMS 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 more information about this policy, visit the Reimbursement Policy page at empireblue.com/provider.

 

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