Every medical biller understands how insurance payers require specific details about every procedure. So, how do you explain the involvement of a team of surgeons? Modifier 66 is your answer. We can say that there is a modifier for every special situation, including surgical scenarios.
But sometimes even professional coders misapply them due to unclear definitions, overlapping descriptions, and confusing usage rules. Today, this blog will cover all aspects of the 66 modifier in detail so you can learn how it is different from other surgical modifiers.
Modifier 66 – Description
Modifier 66 is an important code for defining team surgery situations. To be more specific, it explains that a team of surgeons was involved in a complex procedure, usually an organ transplant. So, what specifies a surgical team in this situation?
It simply means more than 2 surgeons of either the same or different specialties. In short, each surgeon in this scenario uses modifier 66 to bill for the procedure and indicate that they all served as the primary surgeon in this collaborative procedure.
Please note that a different modifier can be used if 2 surgeons, both from different specialities, were involved in a procedure and both served as the primary surgeon for their part. It is modifier 62, also known as the co-surgery modifier.
Accurate Usage Guidelines for Modifier 66
Healthcare providers primarily face denials and lower reimbursements due to the inappropriate use of modifiers. When it comes to modifier 66, many confuse it with assistant surgeon codes. However, it is a team surgery code. So, what are the accurate usage guidelines for modifier 66? Let’s find out.
Accurate Use of Modifier 66
You can use this modifier in the following scenarios:
- When the procedure requires the expertise of more than 2 highly skilled surgeons of the same or different specialties.
- When the procedure requires the coordination of a surgical team due to the use of complex or specialized equipment.
- If the procedure is for an organ transplant.
- If you can justify the involvement of a surgical team with complete documentation.
Important Reminder: You cannot use this modifier with just any code. Our advice is to always check the indicator column in the Medicare Physician Fee Schedule to determine whether you can use this code with certain services. Here is what each value in that column indicates:
| Indicator Value | Definition |
|---|---|
| 0 | A surgical team is not allowed for this procedure. |
| 1 | A surgical team could be paid if the supporting documentation can justify its involvement. |
| 2 | A surgical team is allowed for this procedure and paid by report. |
| 9 | The concept of a surgical team does not apply. |
Inaccurate Use of Modifier 66
On the other hand, avoid using this modifier if:
- 2 or fewer surgeons are involved in the procedure.
Appropriate Use Cases for Modifier 66
If you are still confused, here are some examples that can help you understand the correct use of modifier 66 and how it is limited only to organ transplants.
Reporting a Surgical Team’s Involvement in a Kidney Transplant
Most living donor transplants out of the reported 7,000 in 2024 were for the kidney in the U.S. So, for this example, suppose a senior citizen with end-stage renal disease (ESRD) is scheduled for a kidney transplant. Due to the complexity of the procedure and the patient’s condition, three surgeons are involved in the operation.
They implant the donor’s kidney while performing a nephrectomy (removal of the diseased kidney from the recipient). All three of them then bill CPT code 50365 with modifier 66.
Billing CPT Code 47135 for Each Primary Surgeon
Liver transplants are also quite complex, requiring a team of highly skilled surgeons. In fact, the number of such procedures reached a record in 2023, totaling 10,660. So, for this example, let’s consider an older man who has chronic end-stage liver disease. He experiences significant complications due to this condition and eventually undergoes a liver transplant.
The procedure is handled by three surgeons who use specialized equipment to perform a distinct task, including removing the diseased liver and placing the donor organ. Given the complexity of the liver allotransplant, the billing team applies modifier 66 to CPT code 47135 for each surgeon.
Final Thought on Modifier 66
Modifier 66 notifies payers about the involvement of three or more surgeons in a procedure. To summarize, this two-digit code helps multiple surgeons involved in a specific operation to receive proper reimbursements for their services.
This co-surgery modifier, however, is often used inappropriately. To encourage its appropriate use, we have covered the 66 modifier in quite detail. You can follow our guidelines to accurately bill each transplant for your surgical team.
