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Under certain circumstances, the skills of two surgeons (usually with different specialties) may be required in the management of a specific surgical procedure.

Category I: Co-Surgeons with 150% of the allowance for the procedure divided equally between the two surgeons. Multiple surgery guidelines will apply if a surgeon performs more than one procedure. Both providers must use modifier 62 on their claims. Surgical procedure requires two or more surgeons who usually have different types of skills and expertise to perform a single procedure, which has two separate but integrated parts, performed during the same operative session under the same anesthesia. The following are examples:

• Current Procedural Terminology (CPT) code 61575 (transoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of lesion;) or CPT code 61548 (hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic) frequently requires a neurosurgeon and otolaryngologist; or CPT code 62223 (creation of shunt; ventriculo-peritoneal, -pleural, other terminus) frequently requires the skills of a neurosurgeon and general surgeon. Both surgeons would bill the same procedure code.
  • Modifier 62 is used.
• CPT code 22558 [arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); lumbar] which may or may not be billed with CPT code 22585 [arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); each additional interspace (list separately in addition to code for primary procedure)] may require the skills of a general surgeon and a neurosurgeon and/or orthopaedic surgeon.
  • Modifier 62 is used.

Category II: Multiple shared co-surgery with each provider reimbursed at 100% of the allowance for their procedures.  Multiple surgery guidelines will apply if a surgeon performs more than one procedure. Both providers must use modifier 62 on their claims. Involves two physicians with different skills billing for different surgical procedures under the same anesthesia. The following are examples:

• CPT code 63015 (laminectomy with explorations and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, [e.g., spinal stenosis]. More than 2 vertebral segments; cervical;) billed with CPT code 22842 (posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments), and CPT code 22600 (arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment) may require the skills of a neurosurgeon and an orthopedic surgeon. Each surgeon would bill the procedure code he or she performed.
• A urologist performs CPT code 51845 (abdomino-vaginal vesical neck suspension, with or without endoscopic control [e.g., Stamey, RAZ, Modified Pereyra]) and a gynecologist performs a hysterectomy CPT code 58150 (total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]). Note that this applies to a urologist and gynecologist. If a gynecologist has specialized training in performing urological procedures and performs a urological procedure and a separate gynecologist performs the hysterectomy, this is not co-surgery or team surgery. 
• A general surgeon performs 19200 Mastectomy, radical, including pectoral muscles, axillary lymph nodes and a plastic surgeon performs CPT code 19367 (breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site.
• A gynecologist performs a hysterectomy and there are procedural complications such as a perforated bowel requiring a general surgeon to repair.
  • Modifier 62 is used.

Category III: Shared care surgery or bilateral procedures with 150% of the allowance for the procedure divided equally between the two surgeons. Multiple surgery guidelines will apply if a surgeon performs more than one procedure. Both providers must use modifier 62 on their claims. Involves two physicians with the same surgical skills who are performing bilateral procedures under the same anesthesia. The following is an example.

• Bilateral total knee replacement.
  • Modifier 62 is used

Category IV: Unrelated co-surgery or team surgery with each provider reimbursed at 100% of the allowance for their procedures. Multiple surgery guidelines will apply if a surgeon performs more than one procedure. Both providers must use modifier 66 on their claims. Requires two or more surgeons with the same or different skills that are operating in different operative fields under the same anesthesia and is frequently performed due to trauma. The following are examples:

• A general surgeon performs a splenectomy and an orthopedic surgeon performs an open reduction internal fixation (ORIF) of the femur during the same anesthesia session.
  • Modifier 66 is used.
• An ear, nose and throat (ENT) physician performs placement of tubes in the ear (CPT code 69436) at the same time as a urologist performs a circumcision (CPT code 54161) or foreskin manipulation including lysis of preputial adhesions and stretching (CPT code 54450).
  • Modifier 66 is used.

Category V: Related co-surgery or team surgery with each provider reimbursed at 100% of the allowance for their procedures. Multiple surgery guidelines will apply if a surgeon performs more than one procedure. Both providers must use modifiers 66 and 22 on their claims. Performed for a very complex surgical procedure such as an organ transplant.

In cases requiring co-surgeons or team surgeons, an assistant surgeon is usually not covered. In all the above instances, if an assistant surgeon is used, individual consideration will be used to determine if the assistant surgeon will be covered. For example: If a general surgeon bills as co-surgeon on CPT code 22558, then he is paid to assist in the entire procedure not just the laparotomy portion. If he only performs the laparotomy, he/she should have billed CPT code 49000. Therefore, if an assistant surgeon is billed when co-surgeons (an orthopedic and neurosurgeon) have both billed CPT code 22558, the assistant surgeon would not be covered.

If two unrelated surgeries are performed by different specialties at the same time and the surgeons do not assist each other, then an assistant surgeon could be considered if determined to be medically necessary. An example of this would be a general surgeon performing a lap inguinal hernia repair at the same time that a plastic surgeon is doing breast reconstruction. An assistant could be considered for the breast reconstruction since the general surgeon did not bill as co-surgeon for this procedure.

Nurse practitioners and physician assistants are not eligible to bill as co-surgeons.

For more information, refer to the Medicare National Correct Coding Initiative (NCCI) webpage.