eccm7862
Networker
Do the providers need to be of a different specialty to bill modifier -62 and receive payment?
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Wiki Modifier 62
- Thread starter eccm7862
- Start date
CBLENNIE
True Blue
The technical description of modifier 62 per EncoderPro does not specify that the surgeons must be of different specialties. However, per Medicare Claims Processing Manual Chapter 12-Physicians/Nonphysician Practitioners section 40.8 Claims for Co-Surgeons and Team surgeons indicates the following regarding billing:
Most commercial insurance companies follow Medicare and require that for use of modifier 62 the surgeons must have different specialties.
Also, it is critical that each surgeon writes their own operative note documenting the exact procedures or part of a procedure they performed. I work for a commercial insurance company, and we often deny modifier 62 claims because the documentation doesn't include the information I stated above.
Most commercial insurance companies follow Medicare and require that for use of modifier 62 the surgeons must have different specialties.
Also, it is critical that each surgeon writes their own operative note documenting the exact procedures or part of a procedure they performed. I work for a commercial insurance company, and we often deny modifier 62 claims because the documentation doesn't include the information I stated above.