MA PPO

Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
MA00.015g

Policy


​This policy applies to professional providers billing professional or outpatient facility claims, for members enrolled in all Company products.​​​


Modifiers 80, 81, 82, and AS indicate instances when it is medically necessary for a primary surgeon to require the services of a surgical assistant during a procedure. The Company applies the following Medicare Physician Fee Schedule database assistant-at-surgery indicators to procedure codes to determine the eligibility for reimbursement consideration for assistant-at-surgery services:


0 = Procedure codes that carry a 0 indicator are subject to medical necessity documentation review for reimbursement consideration for assistant-at-surgery services.

  • Upon receipt and processing of claims submitted, the Company will communicate any additional supporting medical necessity documentation requirements. However, providers should not submit medical records to the Company until notified.

= Procedure codes that carry a 1 indicator are not eligible for reimbursement consideration for assistant-at-surgery​ services. The Centers for Medicare & Medicaid Services (CMS) has determined that these services never warrant an assistant-at-surgery.

  • All claims received for reimbursement for assistant-at-surgery services represented by procedure codes with a 1 indicator will be denied by the Company.

2 = Procedure codes that carry a 2 indicator are eligible for reimbursement consideration for assistant-at-surgery services.​

9 = The concept of assistant-at-surgery does not apply to procedure codes that carry a 9 indicator.

  • All claims received for assistant-at-surgery services that are represented by procedure codes that carry a 9 indicator, and for which the concept of assistant-at-surgery does not apply, and considered invalid procedure code/modifier combination.

When assistant-at-surgery services meet all reimbursement eligibility requirements in this policy, such services are reimbursed at 16 percent of the surgical allowance.

In a teaching hospital, with a Graduate Medical Education (GME) program, assistant-at-surgery services performed by a physician or non-physician healthcare practitioner (i.e. PA, or NP/CRNP, or CNS)​ are not eligible for reimbursement consideration by the Company except for the following circumstances; 

  • When exceptional medical circumstances (e.g. emergency, life-threatening situations such as multiple traumatic injuries) require immediate treatment.
  • A surgeon does not participate in the teaching facility's GME program and/or the primary surgeon has a policy never to involve residents in the preoperative, operative or postoperative care of patients. 

Interns, residents, or fellows in GME programs are not recognized as eligible professional providers and, therefore, the Company does not consider assistant-at-surgery services provided by interns, residents, or fellows in GME programs as eligible for reimbursement consideration, regardless of the procedure code indicator.


ADDITIONAL INFORMATION

  • Multiple procedures reported as assistant-at-surgery services are subject to multiple surgery reduction guidelines.
  • The postoperative period corresponding to the procedure code is not applied to assistant-at-surgery services. 
  • Only one physician or non-physician healthcare practitioner performing assistant-at-surgery services​ is eligible for reimbursement consideration.
  • For assistant-at-surgery services to be eligible for reimbursement consideration, the service must be a covered benefit. Individual member benefits must be verified.​

​REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the p​rofessional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.​


The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Claims submitted with modifier 80, 81, 82, and AS are subject to pre- and post-payment review and potential denials or retractions for inappropriate use.​


BILLING REQUIREMENTS

The Company has established the following requirements for the appropriate reporting of Modifiers 80, 81, 82, and AS:

  • The assistant surgeon modifier (80, 81, 82, or AS) that accurately represents the circumstance in which the surgery was performed must be reported. 
  • Assistant-at-surgery services provided by a physician or non-physician healthcare practitioner (i.e. PA, or NP/CRNP, or CNS) must be reported with the same procedure code(s) as reported by the primary surgeon. 
    • Each procedure code representing an assistant-at-surgery service performed by a non-physician healthcare practitioner must be appended with an assistant-surgery modifier (80, 81, 82) in the first modifier position and modifier AS (non-physician health care practitioner) in the second modifier position.
    • Assistant-at-​surgery services should not be reported for 'global' procedures (e.g. maternity care). Assistant-at-surgery services may be reported for 'non-global' surgical procedures (e.g. delivery only) when appropriate.​​
  • Assistant-at-surgery services performed by a nonphysician health care practitioner must meet all local, state, and national licensing, certification, and supervision requirements. (removed from previous sub-bullet to its own stand alone bullet)​
  • The assistant-at-surgery may not report any other service, surgical or otherwise (e.g., co-surgery), during the same operative session.​

Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, assistant-at-surgery services are covered under the medical benefits of the Company's products.​


This policy is consistent with Current Procedural Terminology (CPT®) and Centers for Medicare & Medicaid Services' (CMS) reporting requirements.​


BILLING GUIDELINES​

In order to receive the appropriate reimbursement, surgical procedures performed by both a primary surgeon and an assistant-at-surgery should be reported as follows:

  • For surgical procedures performed on the same date of service, the primary surgeon should submit a claim form with the surgical procedure code(s) for the services performed, and the assistant-at-surgery should submit a separate claim form with the same surgical procedure code(s) reported by the primary surgeon appended with the appropriate modifier.
  • For surgical procedures performed on different dates of service, the primary surgeon should submit a separate claim form for each date of service with the surgical procedure code(s) for the services performed. The assistant-at-surgery should submit a separate claim form from the primary surgeon for each date of service with the same surgical procedure codes(s) reported by the primary surgeon appended with the appropriate modifier.​

Description


​When a surgical procedure, due to its complexity and/or duration, requires both a primary and assistant surgeon, the assistant surgeon actively supports the primary surgeon during the procedure. The following modifiers are appended to procedure codes when appropriate to report assistant-at​-surgery services: 

  • ​Modifier 80: Assistant Surgeon
    • ​Modifier 80 represents the services of a physician serving as an assistant surgeon to a primary surgeon.
  • Modifier 81: Minimum Assistant Surgeon
    • Modifier 81 represents services performed by an assistant surgeon not present throughout the entirety of a procedure.  The minimum assistant surgeon often serves as the second or third assistant surgeon
  • Modifier 82: Assistant Surgeon [when qualified resident surgeon not available]
    • Modifier 82 represents services of an assistant surgeon at a teaching facility when a qualified resident is not available. 
  • Modifier AS: Physician Assistant (PA), Nurse Practitioner (NP/CRNP) or Clinical Nurse Specialist (CNS) services for Assistant-at-surgery
    • Modifier AS represents assistant-at-surgery services provided by non-physician providers. 

​As used in this policy a teaching hospital is a facility with an approved GME program in medicine, osteopathy, dentistry, or podiatry.


As used in this policy, the term assistant surgeon may refer to either a physician (i.e., medical doctor [MD], doctor of osteopathy [DO]), or a nonphysician health care practitioner (i.e., PA, NP/CRNP, or CNS) who provides assistant-at-surgery services.​​



Coding

CPT Procedure Code Number(s)

Refer to the CMS Physician Fee Schedules’ page to perform a search for Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) within the ASST SURG column: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html

Select the calendar year and RVU. The RVU is separated by quarters:
RVUA (January - March)
RVUB (April-June)
RVUC (July-September)
RVUD (October - December)


ICD - 10 Procedure Code Number(s)
N/A

ICD - 10 Diagnosis Code Number(s)
N/A

HCPCS Level II Code Number(s)
Refer to the CMS Physician Fee Schedules’ page to perform a search for Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS)​ within the ASST SURG column: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html

Select the calendar year and RVU. The RVU is separated by quarters:
RVUA (January - March)
RVUB (April-June)
RVUC (July-September)
RVUD (October - December)

Revenue Code Number(s)
N/A

Modifiers

80    Assistant surgeon
81    Minimum assistant surgeon
82    Assistant surgeon (when a qualified resident is not available)
AS   Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant-at-surgery

Coding and Billing Requirements



Policy History

3/29/2021
3/29/2021
MA00.015
Claim Payment Policy Bulletin
Medicare Advantage
No