Modifier 66: Appropriate Use
Modifier 66: Team Surgery
Under some circumstances, highly complex procedures (requiring the concomitant services of several physicians or other qualified health care professionals, often of different specialties, plus other highly skilled, specially trained personnel, various types of complex equipment) are carried out under the ‘surgical team’ concept. Such circumstances may be identified by each participating individual with the addition of modifier 66 to the basic procedure number used for reporting services.
Modifier 66 should not be used for two or less surgeons.
Defining ‘Team of Surgeons’
- If a team of surgeons (more than 2 surgeons of different specialties) is required to perform a specific procedure, the procedure is considered a team surgery. Each surgeon bills for the procedure code with modifier 66 appended.
- Two or more surgeons of the same specialty may not perform sequential procedures (a.k.a. ‘tag-team surgeries’), bill different, specific CPT codes not billed by the other surgeon, and both be reimbursed as primary surgeries at 100%.
- For example, two sequential eye surgeries by different eye surgeons, or two sequential orthopedic surgeries by different orthopedic surgeons.
- Both/all surgical procedures should be performed by a single surgeon with the second surgeon acting as the assistant or as a co-surgery session and submitted according to modifier 62 guidelines.
- If sequential surgery claims are identified:
- The first surgeon’s claim processed will be allowed the primary surgical procedure at 100%.
- The second surgeon’s claim processed will be subject to multiple surgery reductions even to the first surgical procedure.
- Adjustments and refund requests will occur if overpayments are identified after the original processing.
Appropriate Use of Modifier 66
- Includes other highly skilled and specially trained personnel
- Includes different types of complex equipment
- Usually confined to organ transplant teams
- Reimbursed ‘by report’
- Medicare Physician Fee Schedule (MPFS) Indicator List
- ‘T’ column indicator 1 or 2
- Claim subject to Medical Review and documentation will be requested
- Every surgeon MUST append modifier 66 to the CPT code
- For the procedures performed as team surgery, all surgeons are expected to bill the exact same combination of procedure codes with modifier 66 appended.
- Any additional procedures specific to each surgeon’s specialty which are also performed in the same operative session may be reported as primary surgeon or assistant surgeon. Multiple surgery guidelines will be applied to the additional procedures even when the primary procedure is subject to team surgery pricing adjustments.
Team Surgery Remibursement
When an eligible procedure is reported with team surgery modifier 66, the total reimbursement for the team of surgeons will be 150% of the applicable fee schedule rate for the procedure code.
- The total team surgery allowance will be divided equally among the team of surgeons
- For team surgery with three surgeons, each surgeon will be reimbursed at 50% of the fee schedule amount.
- For team surgery with four surgeons, each surgeon will be reimbursed at 37.5% of the fee schedule amount.
- No additional assistant surgeon claims will be allowed for the procedure codes reported with team surgery modifier 66.
- If there is more than one procedure performed, multiple procedure reduction rules apply.
- When co-surgery occurs, a maximum of one procedure code will be processed as a primary surgical procedure code.
- When a team surgeon acts as a primary surgeon on a separate procedure code(s) not included in the team surgery reimbursement (not billed by any surgeon with modifier 66 appended):
- The additional procedure code(s) should be reported without team surgeon modifier 66 appended.
- Multiple surgery guidelines will be applied to the additional procedure(s) even when the primary procedure is subject to team surgery (modifier 66) pricing adjustments.
- When a team surgeon acts as an assistant surgeon on a separate procedure code not included in the team surgery reimbursement (not billed by any surgeon with modifier 66 appended), the appropriate assistant surgery modifier should be appended. Team surgery modifier 66 should not be appended.
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We hope this article would have given you all the necessary information to use modifier 66 appropriately. If you are still not sure and need help in medical billing for your practice, you can always contact us. E2E Medical Billing Services has an experienced billing and coding team that uses exact modifiers to bring accurate insurance reimbursement. To know more about our medical billing services call us at 888-552-1290 or write to us at [email protected]