Billing modifiers 62 , 66 , 73 & 74

Medicare Part B modifiers - 62

Two surgeons: Under certain circumstances the skills of two surgeons (usually with
different skills) may be required in the management of a specific surgical procedure.
Under such circumstances the separate services may be identified by adding the modifier
62 to the procedure number used by each surgeon for reporting his services.

Under some circumstances the individual skills of two surgeons are required to
perform surgery on the same patient during the same operative session. This
may be required because of the complex nature of the procedure(s) and /or the
patient’s condition.

If two surgeons, usually with different skills, are required to perform a single
surgical procedure, each surgeon bills for the procedure with modifier 62. Cosurgery
also refers to single surgical procedures involving two surgeons performing
the parts of the procedure simultaneously, e.g., heart transplant or bilateral knee

replacements. Documentation of the medical necessity for two surgeons is required
for certain services identified by Centers for Medicare & Medicaid Services (CMS).


Medicare Part B modifiers - 66

Surgical Team: Under some circumstances, highly complex procedures (requiring the
concomitant services of several physicians, often of different specialties, plus other
highly skilled, specially trained personnel and various types of complex equipment) are
carried out under the “surgical team” concept. Such circumstances may be identified by
each participating physician with the addition of the modifier 66 to the basic procedure
number used for reporting services.

All claims for team surgeons must contain sufficient information
i.e., operative reports, to allow pricing “by report”.


Medicare Part B modifiers - 73

Discontinued out-patient hospital/ambulatory surgical center (ASC) procedure prior to
the administration of anesthesia: due to extenuating circumstances or those that
threaten the well being of the patient, the physician may cancel a surgical or diagnostic
procedure subsequent to the patient’s surgical preparation (including sedation when
provided, and being taken to the room where the procedure is to be preformed), but prior
to the administration of anesthesia (local, regional block(s) or general). Under these
circumstances, the intended service that is prepared for but cancelled can be reported
by its usual procedure number and the addition of the modifier 73.

Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.

Medicare Part B modifiers - 74

Discontinued out-patient hospital/ambulatory surgical center (ASC) procedure after
administration of anesthesia: due to extenuating circumstances or those that threaten
the well being of the patient, the physician may terminate a surgical or diagnostic
procedure after the administration of anesthesia (local, regional block(s) or general) or
after the procedure was started (incision made, intubation started, scope inserted,
etc.). Under these circumstances, the procedure started but terminated can be reported
by its usual procedure number and the addition of the modifier 74.

Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.

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