Reimbursements

Category:

Surgical Team

Reimbursement Policy: NDRP-Surg-004
Section: Surgery
Effective Date: July 1, 2018
Last Reviewed:
February 24, 2019

Description:

This policy addresses reimbursement for eligible surgical team procedures

Definitions:

A Surgical Team is defined as two or more surgeons with different skills, and generally of different specialties, working together to carry out various procedures of a complicated case.

Policy:

The Plan will reimburse surgical team procedures at 62.5% of the contract allowance, per surgeon per procedure.  If there are multiple surgeries, the multiple surgery reductions will be applied.

Providers should append modifier 66 to codes that are being billed under this policy.

Cross Reference:

2018 National Physician Fee Schedule Relative Value File January Release

–          Team Surgery – Code 2