Co-Surgery — Modifier -62

Definition

Modifier -62 (Two Surgeons) is appended when two surgeons — each acting as a primary surgeon, not an assistant — perform distinct parts of the same single CPT-defined procedure during the same operative session because the complexity of the case requires two different skill sets.¹ Co-surgery is not two surgeons doing the same task together; it’s two surgeons each contributing a different, definable portion of one procedure.²

Core Eligibility Rules

• Both surgeons must report the same CPT code and the same diagnosis code.³
• Medicare generally requires the two surgeons be of different specialties (non-Medicare payers may allow same-specialty co-surgery based on differing surgical skill, per payer policy).⁴
• Each surgeon submits their own operative note documenting their distinct portion of the work.⁵
• Both claims must carry modifier -62, or Medicare pays one surgeon 100% and denies the other outright.⁶
• If surgeons of different specialties each perform a genuinely different procedure (separate CPT codes), neither co-surgery nor multiple-surgery rules apply — even through the same incision.⁷

MPFS Co-Surgery Indicator (Verify Every Code)

Before appending -62, check the Co-Surgery (CO-SURG) indicator on the CMS Medicare Physician Fee Schedule Look-Up Tool for that specific CPT code:⁸

Indicator	Meaning
0	Co-surgeons not permitted — will not be paid
1	Co-surgeons may be paid — documentation required to establish medical necessity
2	Co-surgeons permitted — no documentation required if the two-specialty requirement is met
9	Concept does not apply

Indicators are updated with each fee schedule cycle — re-verify annually, not just once.⁹

Reimbursement

• Each co-surgeon is paid 62.5% of the MPFS allowable for the shared procedure code — totaling 125% split between the two.¹⁰
• Payment is the lesser of actual charges or the 62.5% calculation.¹¹
• Billed amounts can differ between the two surgeons, but the procedure/diagnosis codes cannot.¹²
• Global surgical package rules apply independently to each participating physician.¹³

Documentation Requirements (Indicator = 1)

When the indicator is “1,” claims should include supporting documentation via the PWK (unsolicited paperwork) process; without it, the claim suspends for manual review.¹⁴ Documentation should establish:

• The clinical picture supporting medical necessity of two surgeons
• Each surgeon’s distinct operative role
• That neither surgeon functioned as an assistant to the other

What -62 Is NOT

• Not modifier -80/-82 (assistant surgeon) — if a co-surgeon steps into an assisting role for an additional procedure in the same session, that additional work is billed separately with -80/-82, not -62.¹⑤
• Never combine -62 and -80 on the same line — a surgeon is either a co-surgeon or an assistant for a given procedure, not both.¹⁶
• Not modifier -66 (team surgery) — team surgery involves more than two surgeons, often of different specialties, working together and is reported under separate team-surgery payment rules (pay-by-report), not the 62.5% split.¹⁷
• Per AMA CPT rules, modifier -62 cannot be appended to instrumentation or grafting codes — it belongs on the primary procedure code and qualifying add-on codes only, when both surgeons continue acting as co-surgeons on those add-ons.¹⁸

Specialty-Relevant Scenarios

Spine/Neurosurgery (frequently seen alongside your 22220 / 22222 anterior osteotomy family) Two surgeons of different specialties (e.g., neurosurgery + orthopedic spine) each perform a distinct part of an arthrodesis — one handles approach/decompression, the other handles instrumentation/fusion prep. Classic Noridian example: CPT 22554, general surgery does the approach and disc excision, orthopedics does the graft placement — both bill 22554-62 at 62.5% each.¹⁹

Otolaryngology/Neurosurgery crossover Combined middle/posterior fossa craniotomy for cerebellopontine angle tumor excision (CPT 61526 family) frequently involves ENT and neurosurgery as co-surgeons under a CO-SURG indicator of “2” — both report the identical code with -62.²⁰ Relevant to your 61315 notes when a combined-approach case crosses specialties.

Urology Complex pelvic exenteration or combined urologic/gynecologic-oncology cases (e.g., cystectomy with concurrent reconstruction) are common co-surgery candidates when a general surgeon or gynecologic oncologist and a urologist each perform a distinct, definable portion.²¹

Ophthalmology Less common for -62 given ophtho’s largely solo procedural scope, but combined orbital/oculoplastic cases involving ophthalmology plus ENT or plastic surgery (e.g., complex orbital fracture repair with sinus involvement) can qualify — verify the specific CPT’s CO-SURG indicator before appending.

Common Denial Triggers

• Missing modifier -62 on one of the two claims (auto-denies the second surgeon)²²
• CO-SURG indicator of “0” on the billed code
• Different CPT or diagnosis codes reported between the two surgeons
• Both surgeons from the same specialty on a Medicare claim without payer-specific same-specialty allowance
• Modifier -62 stacked with -80 on the same procedure line

CIC/Inpatient Note

For inpatient professional fee coding, remember co-surgery is a physician fee-schedule (Part B professional) concept tied to the MPFS — it does not affect facility-side MS-DRG assignment. Don’t confuse this with team surgery (-66) or with the CDI concept of multiple attending documentation.

---

1. Priority Health, "Modifiers 62 and 66, Multiple Surgeons," accessed 2026. 2. AAPC, "4 Modifier 62 Tips," AAPC Coding Newsletter. 3. FCSO Medicare, "Modifier 62 Fact Sheet," 2026. 4. AAPC General Coding Alert, "Understand When to Append Modifier 62." 5. Johns Hopkins Health Plans, "Two Surgeons/Co-Surgeons Modifier 62" (RPC-031). 6. Noridian Medicare, JE/JF Part B, "Modifier 62," 2026. 7. Noridian Medicare, JE/JF Part B, "Modifier 62," 2026. 8. CodingAhead, "Modifier 62 Explained: 2026 Billing & Documentation Guide." 9. CodingAhead, "Modifier 62 Explained: 2026 Billing & Documentation Guide." 10. CMS Internet Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Ch. 4, §250.10. 11. FCSO Medicare, "Modifier 62 Fact Sheet," 2026. 12. FCSO Medicare, "Modifier 62 Fact Sheet," 2026. 13. Johns Hopkins Health Plans, RPC-031, "Two Surgeons/Co-Surgeons Modifier 62." 14. FCSO Medicare, "Modifier 62 Fact Sheet," 2026. 15. Priority Health, "Modifiers 62 and 66, Multiple Surgeons," accessed 2026. 16. Kansas Medical Assistance Program, "Coding Modifiers Table." 17. Priority Health, "Modifiers 62 and 66, Multiple Surgeons," accessed 2026. 18. Priority Health, "Modifiers 62 and 66, Multiple Surgeons," accessed 2026. 19. Noridian Medicare, JE/JF Part B, "Modifier 62," 2026. 20. AAPC, "4 Modifier 62 Tips," AAPC Coding Newsletter (Otolaryngology Coding Alert example). 21. Medibill MD, "What Is Modifier 62?" 22. Noridian Medicare, JE/JF Part B, "Modifier 62," 2026.