Modifier 66 of Current Procedural Terminology (CPT®) describes when three or more surgeons of the same or separate specialties collaborate as primary surgeons to conduct different components of a surgical procedure.
This modifier refers to a single, massively complicated surgery or procedure requiring the participation of several physicians from the same or distinct specialties.
Modifier 66 Team surgery
Under certain conditions, highly complex processes (requiring the simultaneous services of several physicians or other competent medical professionals, often from different specialties, and other highly-skilled, exceptionally trained personnel and various types of complex equipment) are carried out using the surgical team’ principle. Each participating person may identify such situations by appending modifier 66 to the primary procedure number used for reports.
Team of surgeons
If a group of surgeons (more than two from different specialties) is needed to conduct a specific protocol, the procedure is referred to as a team surgery. Each surgeon expenses for the procedure code with modifier 66 attached. Two or more surgeons of the same specialty may not operate sequential processes for specific process and CPT codes not charged by the other surgeon, and both be compensated as primary surgeries at 100%.
For example, Two consecutive eye surgeries performed by different eye surgeons or two orthopedic surgeries performed by other orthopedic surgeons. Both/all surgical procedures should be carried out by a single surgeon, with the second surgeon acting as an assistant or as a co-surgery discussion, and should be required to submit under modifier 62 rules.
If claims for sequential surgery are discovered:
The main surgical procedure will be permitted at 100% for the first surgeon’s claim processed. The second surgeon’s claim will be subject to multiple surgery decreases, even for the first surgical procedure.
If overpayments are discovered after the initial processing, adjustments and reimbursement requests will be made.
Suitable use of modifier 66
· Highly qualified and adequately trained personnel are included.
· Various types of advanced products are included.
· Typically restricted to organ transplant teams.
· Indicator List ‘T’ column indicator 1 or 2 for Medicare Physician Fee Schedule (MPFS).
· The claim will apply to medical evaluation, and paperwork will be required.
· Modifier 66 must be added to the CPT code by every surgeon.
All surgeons are anticipated to bill the same mixture of processes and requirements for team surgical planning with modifier 66 appended. Any extra procedures performed in the same operative session particular to each surgeon’s specialty may be noted as primary surgeon or assistant surgeon. Even if the immediate process applies to team surgical procedures pricing adjustments, multiple surgery regulations will be implemented to the additional measures.
Reimbursement for Team surgery
· When a qualified procedure is reported with team surgery modifier 66, the overall reimbursement for the surgical team is 150 percent of the relevant fee schedule price for the procedure code.
· The complete team surgery stipend will be distributed equally among the surgeons on the squad.
· Each surgeon will be repaid at 50% of the fee schedule quantity for team surgery with three surgeons.
· Each surgeon will be reimbursed at 37.5 percent of the fee schedule amount for squad surgery with four surgeons.
· Extra assistant surgeon claims for procedure codes revealed with team surgery modifier 66 will not be permitted.
· Numerous procedure reduction regulations apply when more than one procedure is done.
· When co-surgery occurs, only one procedure code will be analyzed as the primary surgical procedure code.
· When a team surgeon acts as the primary surgeon on a completely separate procedure code(s) that is not covered by the team surgery reimbursement (not billed by any surgeon with modifier 66 appended): the extra procedure code(s) should be revealed even without team surgeon modifier 66 attached.
· Even if the primary procedure applies to team surgery (modifier 66) valuation adjustments, multiple surgery guidance will be implemented to the extra process.
· The suitable assistant surgery modifier should be added when a team surgeon conducts as an associate surgeon on a separate procedure code that is not covered by team surgery reimbursement (not invoiced by any surgeon with modifier 66 attached).
We hope that this article has provided you with all of the information you need to use modifier 66 correctly. If you are still unsure and require assistance with medical billing for your practice, please contact us. Billing executive has a skilled billing and coding team that employs precise modifiers to ensure accurate insurance reimbursement. To learn more about our medical billing services, please contact us at firstname.lastname@example.org
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