Modifier 66

Team Surgeons - Surgical Team

If a team of surgeons (more than 2 surgeons of different specialties) is required to perform a specific procedure, each surgeon bills for the procedure with a modifier 66. Sufficient documentation must establish that a team was medically necessary. All claims for team surgeons must contain sufficient information to allow pricing "by report."

Instructions

This modifier states a single, highly complex surgery or procedure that requires several physicians from the same or different specialties.

Correct Use

  • 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

Incorrect Use

  • Not appropriate for two or less surgeons

Claim Coding Example

Treatment Description CPT/Modifier
Renal allotransplantation, implantation of graft; with recipient nephrectomy 50360 66

 

Resource

 

Last Updated Wed, 08 Sep 2021 17:29:04 +0000