Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 00.10.17i


Attachment:B

Policy #:00.10.17i

Description:Eligible Indicators 1 and 2 Procedure Codes

Title:Modifier 66: Surgical Team


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.


Medicare Physician Fee Schedule Database Indicator 1 and 2 Codes

PROCEDURE CODES
0483T
0484T
15999
17999
19499
20999
21089
21299
21499
21899
22818
22819
22862
22865
22899
22904
22905
22999
23929
24999
25999
26989
27299
27599
27899
28899
29799
29999
30999
31299
31599
31899
32851
32852
32853
32854
32999
33340
33361
33362
33363
33364
33365
33366
33367
33368
33369
33477
33866
33935
33945
33955
33956
33963
33964
33985
33986
33987
33988
33989
33999
36299
37501
37799
38129
38589
38999
39499
39599
40799
40899
41019
41599
41899
42299
42699
42999
43289
43499
43659
43999
44238
44799
44899
44979
45399
45499
45990
45999
46999
47135
47140
47141
47379
47399
47579
47999
48554
48556
48999
49329
49659
49904
49999
50360
50365
50549
51999
53899
54699
55559
55874
55876
55899
58578
58579
58679
58999
59898
59899
60699
61580
61581
61582
61583
61584
61585
61586
61590
61591
61592
61595
61596
61597
61598
61600
61601
61605
61606
61607
61608
61611
61613
61615
61616
61618
61619
63081
63082
63085
63086
63087
63088
63090
63091
64569
64570
64999
65855
66999
67299
67399
67599
67999
68399
68899
69399
69799
69949
69979
93591
93998
G0186

Version Effective Date: 12/16/2019
Version Issued Date: 12/16/2019
Version Reissued Date: N/A

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.