Procedures Billed With Two or More Surgical Modifiers

40.9 - Procedures Billed With Two or More Surgical Modifiers (Rev. 1, 10-01-03) B3-4829 A/B MACs (B) may receive claims for surgical procedures with more than one surgical modifier. For example, since the global fee concept applies to all major surgeries, A/B MACs (B) may receive a claim for surgical care only (modifier “-54”) for a bilateral surgery (modifier “-50”). They may also receive a claim for multiple surgeries requiring the use of an assistant surgeon. Following is a list of possible combinations of surgical modifiers. (NOTE: A/B MACs (B) must price all claims for surgical teams “by report.”) • Bilateral surgery (“-50”) and multiple surgery (“-51”). • Bilateral surgery (“-50”) and surgical care only (“-54”). • Bilateral surgery (“-50”) and postoperative care only ("55”). • Bilateral surgery (“-50”) and two surgeons (“-62”). • Bilateral surgery (“-50”) and surgical team (“-66”). • Bilateral surgery (“-50”) and assistant surgeon (“-80”). • Bilateral surgery (“-50”), two surgeons (“-62”), and surgical care only (“-54”). • Bilateral surgery (“-50”), team surgery (“-66”), and surgical care only (“-54”). • Multiple surgery (“-51”) and surgical care only (“-54”). • Multiple surgery (“-51”) and postoperative care only ("55”). • Multiple surgery (“-51”) and two surgeons (“-62”). • Multiple surgery (“-51”) and surgical team (“-66”). • Multiple surgery (“-51”) and assistant surgeon (“-80”). • Multiple surgery (“-51”), two surgeons (“-62”), and surgical care only (“-54”). • Multiple surgery (“-51”), team surgery (“-66”), and surgical care only (“-54”). • Two surgeons (“-62”) and surgical care only (“-54”). • Two surgeons (“-62”) and postoperative care only (“55”). • Surgical team (“-66”) and surgical care only (“-54”). • Surgical team (“-66”) and postoperative care only (“55”). Payment is not generally allowed for an assistant surgeon when payment for either two surgeons (modifier “-62”) or team surgeons (modifier “-66”) is appropriate. If A/B MACs (B) receive a bill for an assistant surgeon following payment for co-surgeons or team surgeons, they pay for the assistant only if a review of the claim verifies medical necessity.