What is Modifier 62 in Medical Billing?

Billing a surgical procedure with a single surgeon is complex enough. When you add a second surgeon to the fold, the medical billing and coding complexity also doubles. Both surgeons work on the same patient, have distinct expertise, and manage separate parts of the procedure. 

So, how do you make sure that both of them get paid fairly? Do you bill for an assistant? Do you bill them separately? If you don’t get the coding right, you risk claim denials. Well, the answer lies in modifier 62. That’s why it is vital for you to understand what the 62 modifier is and how you can use it properly in your claims. So, let’s start. 

Modifier 62 – Description

Modifier 62 simply represents “Two Surgeons.” As evident from the definition, the modifier simply states that two surgeons worked together as primary surgeons to perform distinct parts of a single reportable procedure.

Please note that this is completely different from the services of an “Assistant Surgeon”. Unlike an assistant surgeon scenario where one physician helps another, modifier 62 is used when both physicians act as “co-surgeons.”

What’s essential to understand here is that when you append modifier 62 to a CPT code, the global fee for that procedure is split. According to the co-surgeon guidelines, the total reimbursement for the procedure in this case is increased to 125% of the original amount. This increased reimbursement amount is then divided equally between the two providers. This means that each surgeon reporting 62 in their claim receives 62.5% of the global fee schedule amount.

Key Characteristics

Remember:

• Both surgeons must function as primary surgeons.
• They must perform distinct parts of the same procedure.
• Both surgeons must bill the same CPT code and append modifier 62.

Modifier 62 – Usage Examples

To better understand modifier 62’s practical usage, let’s look at a couple of scenarios in which it can be used:

Spinal Surgery

A good example can be of spinal surgery. Since spine surgeries are very complex, they are often performed by more than one physician. For instance, a general surgeon or vascular surgeon might make the incision and carefully move the blood vessels and organs to expose the spine. After this, an orthopedic surgeon or a neurosurgeon might step in to perform the actual fusion or instrumentation work.

In this case, the billing department can use modifier 62 to bill the services of two surgeons. 

Pituitary Tumor Removal

Consider a patient undergoing tumor removal from his pituitary gland. An otolaryngologist (ENT) will be responsible for the access. Meaning, he will navigate through the nasal cavity and the sphenoid sinus to create a corridor to the base of the skull. Simultaneously or immediately after it, a neurosurgeon will perform the actual work. That is, he will open the sella turcica (the bone cradling the pituitary), incise the dura, and remove the tumor.

Since both physicians operated in the same space to achieve the same goal, tumor removal, modifier 62 would be necessary to indicate the shared responsibility.

Accurate Usage Guidelines for Modifier 62

You can’t just use this modifier every time two surgeons enter the operating room during a procedure. It should be used under strict guidelines. The following are some points to note:

Check the Payment Policy Indicators

Before you even think about billing, you must check the Medicare Physician Fee Schedule Database (MPFSDB). Every CPT code is assigned a “Co-surgery” indicator, which dictates if modifier 62 is allowed. Here’s what the different indicators mean:

Indicator	Meaning	Action Required
0	Co-surgeons not permitted	Do not bill the 62 modifier. Claims will be denied.
1	Co-surgeons may be paid with documentation	Supporting documentation is required to establish medical necessity.
2	Co-surgeons permitted	No special documentation is required if the two surgeons are of different specialties.
9	Concept does not apply	Co-surgeons are not required for the procedure represented by this code.

Provide Detailed Documentation

Documentation is where most modifier 62 claims fail. It is not enough for just one surgeon to dictate the operative report. Both surgeons must document their distinct work.

• Submission: Two separate operative reports should be submitted, or one combined report with two distinct, signed sections.
• Required Detail: Each surgeon must clearly describe the portion of the procedure they performed.

Understand Same Specialty vs. Different Specialty

Generally, payers expect co-surgeons to be from different specialties (e.g., a neurosurgeon and an orthopedic surgeon). If two surgeons of the same specialty use modifier 62, most payers (especially Medicare) will assume they were acting as assistants rather than co-surgeons.

If the procedure has a status indicator of “2,” the surgeons must be of different specialties. If they are the same specialty, you will likely face a denial unless the medical necessity is overwhelmingly clear and documented.

Final Thoughts 

Finally, we have reached the end of this guide. Let’s recap some of the important points.

• Modifier 62 is used to bill services of two surgeons during the same operative session.
• Before using 62 on your claims, always check the status indicator of the applied CPT code. 
• Provide detailed documentation with your claims.
• Under the 62 modifier, each healthcare provider receives 62.5% of the reimbursement amount. 

By following the guidelines mentioned in this blog, we hope you will be able to use the 62 modifier properly in your claims and get fair reimbursement for your services. However, if confusion persists, we recommend opting for professional medical billing and coding services. 

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