Professional Reimbursement Policy for Assistant Surgeon Services
Coverage is subject to the terms, conditions, and limitations of an individual member’s programs or products and policy criteria listed below.
The American College of Surgeons (ACS) has determined that assistant surgeon services are required for the successful completion of certain surgical procedures that have been identified as sufficiently complex or intensive.
Providers rendering assistance at surgery (“Assistant Surgeon services”) should report such services by appending the modifier 80, 81, 82, or AS, as appropriate, to a specific Current Procedural Terminology (CPT®1) code. Each modifier identifies a unique situation.
• 80 ‐ Physician providing assistance in surgery
• 81 ‐ Physician providing minimum assistance in surgery
• 82 ‐ Physician providing assistance in surgery when qualified resident not available
• AS – Non‐physician providing assistance in surgery (such as an RNFA or PA)
The Health Plan considers the following points to be important considerations in the adjudication of an Assistant Surgeon claim:
1. The provider of service must be a licensed practicing M.D., D.P.M., D.D.S., D.O., Physician Assistant (PA), RNFA (Registered Nurse First Assistant) or CNM (Certified Nurse Midwives) to be eligible for reimbursement as an Assistant Surgeon for a covered procedure.
2. Only one Assistant Surgeon is eligible for reimbursement per covered surgical procedure.
3. CPT codes reported with an Assistant Surgeon modifier are subject to multiple surgery reimbursement rules, if applicable. Assistant Surgeon services are eligible for reimbursement as follows:
• Assistant Surgeon services reported with modifiers 80, 81, and 82 will be eligible for reimbursement at 16% of the allowed amount for the primary procedure. Multiple surgery reimbursement rules are applied to subsequent procedures, if applicable.
• Assistant Surgeon services reported with modifier AS will be eligible for reimbursement at 16% of the allowed amount under the applicable physician extender fee schedule. If there is no applicable physician extender fee schedule, the Assistant Surgeon services will be eligible for reimbursement at 10% of the allowed amount for the primary procedure. Multiple surgery reimbursement rules are applied to subsequent procedures, if applicable.
4. Procedures reported with an unlisted CPT code will be retrospectively reviewed for pricing and eligibility for reimbursement for an Assistant Surgeon.
5. Assistant Surgeon claim editing is administered uses edit designations that are tailored to physicians. However, the Health Plan applies the same edit designations to non‐physician assistants.