Neurosurgery Coding Alert

Question: Are there any special requirements for appending modifier -66?

Maine Subscriber

Answer: Apply modifier -66 (Surgical team) when a team of surgeons (three or more) works together to complete a procedure reported using a single CPT code. The requirements for modifier -66 are similar to those for modifier -62 (Two surgeons): Each physician bills independently, and each provides his or her own operative report and documentation.

Team surgeries are uncommon and generally involve complex procedures such as organ transplants. Neurosurgeons might be involved in such surgery during cranial reconstructions or severe trauma cases, which might also involve, for instance, orthopedic or plastic surgeons.

Payers will review modifier -66 claims on a case-by-case basis. Reimbursement among the physicians is determined at the time of review based on documentation provided. Many payers maintain a list of procedures for which modifier -66 is justified. If possible, you may wish to contact your payer prior to surgery to determine if it has any special instructions.

Note that if several surgeons work together during the same operative session but report distinct procedures (i.e.,  nonbundled procedures with their own CPT codes), modifier -66 is not necessary. Similarly, two surgeons working together with the aid of a surgical assistant do not qualify as a surgical team as defined by modifier -66. The team must consist of three or more primary surgeons.