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PAP510 - CPT Modifier 62 - Revised with reporting instructions.
Act
by Jun 1, 2026
Effective date
Jun 1, 2026
Identified
Sep 29, 2026
Summary
Blue Cross of Idaho revised its CPT Modifier 62 policy (effective June 2026) to clarify co-surgeon billing requirements. Surgical procedures billed with modifier 62 are reimbursed at 62.5% of the maximum procedural allowance. The revision adds explicit reporting instructions requiring both co-surgeons to submit separate claims with their individual NPIs, identical CPT and diagnosis codes, and documentation supporting distinct surgical responsibilities.
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What to do
by Jun 1, 2026 · 8 steps
01Billing team must implement the following for all co-surgeon cases billed with modifier 62.
02Ensure both surgeons submit separate claims from their individual NPIs with identical CPT and diagnosis codes.
03Verify documentation in the medical record clearly supports medical necessity and distinct responsibilities of each surgeon.
04Confirm the CPT code is CMS-designated as eligible for co-surgeon use.
05Apply 62.5% reimbursement rate to maximum procedural allowance or billed charge, whichever is less.
06Update billing system templates and provider communications to reflect these requirements.
07Train providers and coders on new documentation standards.
08Claims submitted without proper co-surgeon agreement, matching codes, or inadequate documentation of distinct responsibilities will be denied or subject to recoupment.
Original notice
PAP510 - CPT Modifier 62 - Revised with reporting instructions.
providers.bcidaho.com · Always check the source before changing claims.