This policy provides guidelines for the reimbursement of services provided by an Assistant Surgeon.
|81||Minimum Assistant Surgeon|
|82||Assistant Surgeon (when qualified resident surgeon not available)|
|AS||Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS) services for Assistant at Surgery|
An assistant surgeon actively assists the primary surgeon performing a surgical procedure. Assistant surgeons submit procedure code(s), with the appropriate modifier appended (80, 81, 82, or AS) to represent their service(s).
The reimbursement amount is dependent upon the assistant surgeon modifier appended to the surgical code(s) submitted. Only one assistant surgeon will be reimbursed for each eligible procedure(s).
|80||20% of the fee schedule|
|81||20% of the fee schedule|
|82||20% of the fee schedule|
|AS||17% of the fee schedule (Fee Schedule Amount x 85%) x 20%|
Note: Multiple procedure reductions may apply if an assistant at surgery submits multiple procedure codes. Refer to the Multiple Procedures Payment Reduction for Medical and Surgical Services Reimbursement Policy for additional information.
Procedure Codes Eligible for Assistant Surgeon Reimbursement:
The assistant at surgery procedure code eligible list is developed based on the Center for Medicare & Medicaid Services (CMS) Physician Fee Schedule (PFS) Relative Value Unit (RVU) File status indicators. All codes in the CMS PFS RVU File with the status indicator “2” for “Assistant at Surgery” are reimbursable for assistant at surgery services, when indicated by an assistant surgeon modifier (80, 81, 82, or AS).
|CMS Definition for Assistant Surgery Status Indicator|
|2||Payment restriction for assistant at surgery does not apply to this procedure. Assistant at surgery may be paid.|
Note: BCBSND updates codes quarterly when made available by The CMS and the American Medical Association (AMA). The official update of the Healthcare Common Procedure Coding System (HCPCS) for public use is located at https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update The official update of the AMA is located at https://www.ama-assn.org/.
Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:
- Group or Individual benefit
- Provider Participation Agreement
- Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
- Mandated or legislative required criteria will always supersede.
In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.
CMS PFS RVU File
Multiple Procedures Payment Reduction for Medical and Surgical Services Reimbursement Policy
|9/19/19||Added CMS status indicators, Limitations and Exclusions, Disclaimer and History.|
|6/26/20||Updated policy section for how assistant surgery claims are submitted. The identical code as the primary surgeon is not required in all situations. |
|4/25/21||Added a note that codes are updated quarterly. |