Modifiers 80, 81, 82, AS; Assistant at Surgery - Medicare Advantage

Policy No: 109
Date of Origin: 10/01/2014
Section: Modifiers
Last Reviewed: 07/01/2019
Last Revised: 07/01/2019
Approved: 07/03/2019
Effective: 08/01/2019

This policy applies only to physicians and other qualified health care professionals.

Definitions

Current Procedural Terminology (CPT®) Modifier 80
CPT Modifier 80 represents assistant at surgery by another physician. This assistant at surgery is providing full assistance to the primary surgeon. This modifier is not intended for use by non-physicians assisting at surgery (e.g. Nurse Practitioners or Physician Assistants).

CPT Modifier 81
CPT Modifier 81 represents minimal assistant at surgery by another physician. This assistant at surgery is providing minimal assistance to the primary surgeon. This modifier is not intended for use by non-physicians assisting at surgery (e.g. Nurse Practitioners or Physician Assistants).

CPT Modifier 82
CPT Modifier 82 represents assistant at surgery by another physician when a qualified resident surgeon is not available to assist the primary surgeon. This modifier is not intended for use by non-physicians assisting at surgery (e.g. Nurse Practitioners or Physician Assistants).

Healthcare Common Procedure Code System (HCPCS) Modifier AS
HCPCS Level II Modifier AS represents a non-physician assisting at surgery.

Assistant at Surgery Indicators
The Centers for Medicare & Medicaid Services (CMS) Assistant at Surgery Indicators (ASST SURG) are found in the CMS National Physician Fee Schedule Relative Value File. Values which are currently in the CMS file are:

0 - Assistant surgeon may be paid with documentation supporting medical necessity
1 - Assistant surgeon cannot be paid
2 - Assistant surgeon can be paid
9 - Assistant surgeon concept does not apply

Policy statement

Our health plan will reimburse physicians and certain non-physician providers for assistant at surgery when the procedure code has been assigned a CMS Assistant at Surgery Indicator 2. Codes with a CMS Assistant at Surgery Indicator of 1 or 9 are not eligible for reimbursement for an assistant at surgery.

Codes with a CMS Assistant at Surgery Indicator of 0 will be denied upon initial adjudication of the claim. However, the claim may be reviewed for reimbursement upon appeal when documentation has been submitted that supports the medical necessity for the assistant surgeon. Our health plan uses MCG in determining medical necessity for assistant at surgery.

In the absence of a CMS Assistant at Surgery Indicator, we may establish an assistant at surgery designation.

Physicians billing for assistant at surgery must assign modifier 80, 81, or 82. Non-physician providers billing for assistant at surgery must assign modifier AS. Our health plan will reimburse for assistant at surgery when the non-physician provider is a nurse practitioner, physician assistant or clinical nurse specialist. Other provider types, including registered nurse without first assist credentials and certified surgical technician will not be reimbursed for assistant at surgery.

The assistant at surgery must report the same codes as the surgeon. An exception to this is when the surgeon bills a global code (e.g., maternity care). In that case, the assistant at surgery must bill the specific surgery code (e.g., delivery only). The same multiple procedure fee reductions and clinical edits apply to the assistant at surgery as the primary surgeon.

When multiple procedures are performed where only some of the codes are eligible for assistant at surgery reimbursement, only the eligible codes will be reimbursed to the provider billing for the assist.

When a physician provider reports an eligible procedure with modifier 80/81/82, reimbursement will be 16% of the allowed amount for physicians.

When a non physician provider reports an eligible procedure with modifier AS, reimbursement will be 16% of the allowed amount for non-physicians. Modifier reimbursement is subject to any reductions set by CMS guidelines and any applicable provider contract language.

References

CMS National Physician Fee Schedule Relative Value File

American Medical Association. Appendix A: Modifiers Current Procedural Terminology (CPT). AMA Press

Cross References

None

Disclaimer

Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.