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

Policy No: 109
Date of Origin: 10/01/2014
Section: Modifiers
Last Reviewed: 08/01/2024
Last Revised: 08/01/2022
Approved: 08/08/2024
Effective: 09/01/2024
Policy Applies to: Medicare Advantage

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

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/Physician Associates).

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/Physician Associates).

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/Physician Associates).

Healthcare Common Procedure Code System (HCPCS) Level II Modifier AS - HCPCS Level II Modifier AS represents a non-physician assisting at surgery (e.g., Nurse Practitioners or Physician Assistants/Physician Associates).

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 (NPFSRVF). Values which are currently in the CMS NPFSRV, 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.

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, upon appeal with submitted documentation, the claim will be reviewed for reimbursement dependent upon the medical necessity for the assistant at surgery being established.

In the absence of a CMS Assistant at Surgery Indicator, our health plan may establish an assistant at surgery designation. Our health plan may employ Milliman Clinical Guidelines (MCG) in determining medical necessity for assistant at surgery.

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/physician associate 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 and 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.

We will only reimburse for one assistant at surgery. We will not reimburse two assistants at surgery at the same surgery. In addition, our health plan will not reimburse for an additional assistant at surgery on a procedure where reimbursement has been provided as co-surgeons.

Centers for Medicare & Medicaid Services (CMS), National Physician Fee Schedule Relative Value File

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

Modifier 62; Two Surgeons/Co-Surgeons