Sunday, September 5, 2010

team of surgeons - cpt modifier 66

Modifier 66 Fact Sheet


Definition:

• If a team of surgeons (more than two surgeons of different specialties) is required to perform a specific procedure, each surgeon bills for the procedure with a modifier “-66.”

Appropriate Use:

• The MPFSDB identifies certain services submitted with a “-66” modifier, which must be sufficiently documented to establish that a team was medically necessary. All claims for team surgeons must contain sufficient information to allow pricing “by report.”

The folowing indicators identify services for which team surgeons may be paid:

0 = Team surgeons not permitted for this procedure.
1 = Team surgeons may be paid if supporting doumentation is supplied to establish medical necessity of a team. Paid by report.
2 = Team surgeons may be paid. Paid by report.

Facts

• Global surgery rules apply to each of the physicians participating in a team surgery.
• Reimbursement is determined “By Report.”

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