Modifier 62 (Two Surgeons) is used when two surgeons work together as primary surgeons, each performing a distinct, medically necessary portion of the same surgical procedure during the same operative session. Unlike an assistant surgeon, both physicians share primary responsibility for the operation and contribute specialized expertise.

Modifier 62 is commonly reported for highly complex procedures such as transplant surgery, certain cardiovascular procedures, neurosurgery, spinal surgery, and reconstructive surgery where the skills of two surgeons are required.

Under Medicare, both surgeons must report the same CPT® procedure code with Modifier 62, provided the procedure is eligible for co-surgery and the documentation supports medical necessity.

Modifier Number

Modifier Name

Two Surgeons

Note: The official CPT® descriptor is maintained by the American Medical Association (AMA). Always refer to the current licensed CPT® codebook for the official wording.

Plain English Explanation

Modifier 62 tells the payer:

“Two surgeons acted as primary surgeons and each performed a distinct portion of the same surgical procedure during the same operative session.”

Neither physician is functioning as an assistant surgeon.

Purpose of Modifier 62

Modifier 62 is used to:

Report co-surgery performed by two primary surgeons.
Identify that each surgeon performed a distinct portion of the same procedure.
Support appropriate reimbursement for complex surgical procedures.
Distinguish co-surgeons from assistant surgeons.
Comply with CMS and payer-specific co-surgery billing rules.

Understanding Co-Surgery

Co-surgery occurs when:

Two surgeons participate in the same operation.
Each surgeon performs separate and essential portions of the procedure.
Both surgeons are considered primary surgeons.
The complexity of the surgery requires specialized skills from both physicians.

Examples include:

Heart transplant.
Complex spinal fusion requiring an orthopedic surgeon and a neurosurgeon.
Vascular and general surgeons jointly performing an abdominal aortic aneurysm repair.
Plastic and orthopedic surgeons performing complex limb reconstruction.

CMS explains that co-surgery is appropriate when the patient’s condition or the complexity of the procedure requires the individual skills of two surgeons.

When to Use Modifier 62

Modifier 62 may be appropriate when:

Two surgeons act as primary surgeons.
Each performs a distinct part of the same procedure.
The procedure is eligible for co-surgery under the Medicare Physician Fee Schedule.
Both surgeons document their individual operative work.
Medical necessity supports the need for two surgeons.

Common Examples

✔ Liver transplant.

✔ Heart transplant.

✔ Complex spinal fusion involving orthopedic and neurosurgical specialists.

✔ Major vascular reconstruction.

✔ Complex pelvic or oncologic surgery requiring surgeons from different specialties.

When NOT to Use Modifier 62

Do not use Modifier 62 when:

One physician only assists another surgeon (Modifiers 80, 81, 82, or AS may apply).
Surgeons perform different CPT® procedures rather than sharing the same procedure.
The procedure is not eligible for co-surgery.
Documentation does not support distinct operative responsibilities.
Only one surgeon performs the entire procedure.

Medicare Rules

CMS has specific billing requirements for Modifier 62.

Important Medicare guidelines include:

Both surgeons must report the same CPT® code with Modifier 62.
Each surgeon must perform a distinct portion of the procedure.
The procedure must have a Medicare co-surgery indicator allowing Modifier 62.
Co-surgery indicators are:
- 0 – Co-surgeons not permitted.
- 1 – Co-surgeons may be paid; documentation required.
- 2 – Co-surgeons permitted; documentation generally not required when specialty requirements are met.
- 9 – Concept does not apply.
Medicare generally reimburses each co-surgeon 62.5% of the allowable amount, resulting in a combined payment of 125% of the physician fee schedule amount.

Commercial Insurance Rules

Commercial payer policies vary.

Many insurers:

Follow CMS co-surgery guidance.
Require operative reports from both surgeons.
Require documentation explaining why two surgeons were medically necessary.
May have procedure-specific co-surgery policies.
May use Medicare co-surgery indicators as billing references.

Always review payer-specific reimbursement policies before claim submission.

Documentation Requirements

Documentation should include:

Complete operative report.
Separate operative notes from each surgeon, when applicable.
Description of each surgeon’s responsibilities.
Medical necessity for co-surgery.
Procedure performed.
Date of surgery.
Physician signatures.

Documentation should clearly demonstrate that both surgeons served as primary surgeons, not as assistant surgeons.

Real Billing Examples

Example 1 – Heart Transplant

A cardiothoracic surgeon and a transplant surgeon jointly perform a heart transplant.

Each surgeon performs distinct operative responsibilities.

Both report the same CPT® code with Modifier 62.

Example 2 – Complex Spine Surgery

An orthopedic spine surgeon performs spinal instrumentation while a neurosurgeon performs decompression during the same operative session.

Both physicians act as primary surgeons.

Modifier 62 is appropriate if the CPT® code permits co-surgery.

Example 3 – Vascular Reconstruction

A vascular surgeon performs arterial reconstruction while a general surgeon completes abdominal exposure and reconstruction as part of the same procedure.

Both surgeons report Modifier 62 when payer requirements are satisfied.

Example 4 – Incorrect Use

A surgeon performs the procedure while another physician merely assists with exposure and retraction.

Modifier 62 is not appropriate.

Assistant-at-surgery modifiers should be considered instead.

CMS-1500 Claim Example

Field	Example
CPT Code	Eligible surgical CPT® code
Modifier	62
Diagnosis Pointer	Appropriate ICD-10-CM diagnosis
Units	1
Charges	Provider’s billed amount

Each co-surgeon submits a separate claim using the same CPT® code and Modifier 62.

Common Denial Reasons

Procedure is not eligible for co-surgery.
Only one surgeon appended Modifier 62.
Documentation does not support two primary surgeons.
Surgeons billed different CPT® codes for the shared procedure.
Medical necessity not established.
Incorrect use instead of assistant surgeon modifiers.

How to Correct the Denial

Review the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA).
Verify the CPT® code’s Medicare co-surgery indicator.
Confirm both surgeons reported Modifier 62.
Submit operative reports describing each surgeon’s responsibilities.
Include documentation supporting medical necessity.
Appeal with complete clinical records if appropriate.

Coding Tips

Verify the CPT® code allows Modifier 62.
Ensure both surgeons append Modifier 62.
Confirm each physician acted as a primary surgeon.
Do not confuse Modifier 62 with assistant surgeon modifiers.
Review Medicare Physician Fee Schedule (MPFS) co-surgery indicators before billing.

Modifier 62 vs Modifier 66 vs Modifier 80

Modifier	Purpose
62	Two primary surgeons perform distinct portions of the same procedure.
66	Surgical team involving multiple physicians and highly specialized personnel.
80	Assistant surgeon assists the primary surgeon but is not a co-surgeon.

Modifier 62 vs Assistant Surgeon Modifiers

Modifier	Description
62	Two primary surgeons
80	Assistant Surgeon
81	Minimum Assistant Surgeon
82	Assistant Surgeon when qualified resident unavailable
AS	Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist assisting at surgery

Frequently Asked Questions (FAQs)

Q1. What is Modifier 62 used for?

Answer: Modifier 62 reports co-surgery when two surgeons work together as primary surgeons, each performing distinct portions of the same surgical procedure.

Q2. Can surgeons from the same specialty report Modifier 62?

Answer: They may, depending on payer policy and the procedure. Medicare frequently applies Modifier 62 when two surgeons’ distinct expertise is medically necessary, and eligibility should be verified using the Medicare Physician Fee Schedule co-surgery indicators.

Q3. Do both surgeons bill the same CPT® code?

Answer: Yes. When reporting co-surgery, both surgeons generally submit the same CPT® code with Modifier 62, provided each performed a distinct portion of the procedure.

Q4. How much does Medicare pay each co-surgeon?

Answer: Medicare generally reimburses each co-surgeon 62.5% of the allowable fee schedule amount, subject to Medicare payment rules and procedure eligibility.

AR Caller Tips

When following up on a denied Modifier 62 claim:

Verify the CPT® code allows co-surgery.
Confirm both surgeons submitted Modifier 62.
Check whether the payer requires operative reports.
Verify that documentation clearly identifies each surgeon’s responsibilities.
Record the payer representative’s name, reference number, and follow-up instructions.

Interview Questions

Question 1

What is Modifier 62?

Answer: Modifier 62 indicates that two surgeons acted as primary surgeons and each performed a distinct portion of the same surgical procedure.

Question 2

What is the difference between Modifier 62 and Modifier 80?

Answer: Modifier 62 is used when both physicians are primary surgeons. Modifier 80 is used when one physician serves only as an assistant surgeon.

Question 3

What should you verify before billing Modifier 62?

Answer: Confirm that the CPT® code permits co-surgery, both surgeons acted as primary surgeons, both reported Modifier 62, and documentation supports medical necessity.

Practice Scenario

Scenario

A patient undergoes a complex anterior lumbar interbody fusion. An orthopedic spine surgeon performs the spinal fusion and instrumentation, while a vascular surgeon performs the surgical exposure and vascular management required for safe access to the spine. Both physicians actively perform distinct, essential portions of the same procedure, and the operative reports clearly document each surgeon’s work.

Question

Should Modifier 62 be reported?

Answer

Yes. Because two primary surgeons performed distinct portions of the same eligible procedure during the same operative session, Modifier 62 is appropriate if payer requirements and the Medicare co-surgery indicator permit its use.

Related Modifiers

Modifier 66 – Surgical Team
Modifier 80 – Assistant Surgeon
Modifier 81 – Minimum Assistant Surgeon
Modifier 82 – Assistant Surgeon (Qualified Resident Unavailable)
Modifier AS – Non-Physician Practitioner Assistant at Surgery

Common Billing Mistakes

Reporting Modifier 62 when one physician is only an assistant.
Only one surgeon appending Modifier 62.
Using different CPT® codes for the same co-surgery.
Ignoring Medicare co-surgery indicators.
Failing to document each surgeon’s distinct operative responsibilities.

Key Takeaways

Modifier 62 identifies co-surgery performed by two primary surgeons.
Both surgeons generally report the same CPT® code with Modifier 62.
The procedure must be eligible for co-surgery under Medicare or payer rules.
Documentation must clearly identify each surgeon’s distinct operative work.
Modifier 62 should never be used for assistant-at-surgery services.

References

CMS Medicare Learning Network – Global Surgery Booklet.
CMS Medicare Claims Processing Manual – Co-Surgeons and Team Surgeons.
CMS Medicare Physician Fee Schedule Database (Co-Surgery Indicators).
Licensed AMA CPT® Codebook for official modifier descriptors.

Conclusion

Modifier 62 plays a critical role in accurately reporting co-surgery when two primary surgeons contribute distinct, medically necessary portions of the same operation. Correct application requires verifying CPT® code eligibility, understanding Medicare co-surgery indicators, ensuring both surgeons report Modifier 62, and maintaining detailed operative documentation. Proper use helps reduce denials, supports compliant billing, and ensures appropriate reimbursement for complex surgical procedures.

Educational Disclaimer

This article was prepared with the assistance of artificial intelligence (AI) for educational and informational purposes. It is based on publicly available CMS guidance, Medicare billing resources, and general medical billing principles. It is not an official publication of the American Medical Association (AMA), CMS, or any insurance payer. CPT® is a registered trademark of the American Medical Association. Always consult the latest AMA CPT® codebook, CMS manuals, Medicare Administrative Contractor (MAC) guidance, National Correct Coding Initiative (NCCI) policies, the Medicare Physician Fee Schedule Database, and payer-specific billing policies before coding, billing, or submitting claims.