September 15, 2016
What is the reimbursement for co-surgery using modifier 62? Is it different for the primary and co-surgeon?
For Medicare, co-surgery requires two different specialties performing separate parts of a single CPT code. For both surgeons, modifier 62 is appended to the appropriate CPT code(s). Medicare multiplies the allowable by 125% and splits the reimbursement exactly in half, resulting in a payment of 62.5% to each surgeon. For example, when neurosurgery and otolaryngology perform an endoscopic transnasal pituitary tumor removal each surgeon reports 62165-62 as the primary procedure code. Both surgeons would receive 62.5% of Medicare’s allowable. So to answer your question, the payment is the same for both surgeons. Both surgeons dictate an operative note describing their work and both have post-operative responsibilities. For private payers, coding guidelines and payment may vary.
*This response is based on the best information available as of 09/15/16.