August 20, 2020

Question:
My Plastic Surgeon is asking about breast reconstruction coding. We use either S2068 and or 19364 depending on the payor. Will these codes allow a co-surgeon (modifier 62) and assistant surgeon (modifier 80) for a total of 3 billed surgeons? When asking providers I can’t seem to get a clear answer.

Answer:
Most payors will not reimburse 3 providers (2 co-surgeons and 1 assistant) on the same CPT code, 19364. In fact, Medicare does not. As for S2068, many payors who recognize this code generally do not recognize payment for an assistant or co-surgeon on the same code. The surgeon typically pays the co-surgeon/assistant out of the revenue collected for S2068.

*This response is based on the best information available as of 08/20/20.