| Modifiers -80, -81, -82 and
-AS – Assistant at Surgery
| Topic: Modifiers -80, -81,
-82 and -AS – Assistant at Surgery |
Date of Origin: December
2009 |
| Section: Modifiers |
Policy No: 109 |
| Last Reviewed Date: September
10, 2010 |
Last Revised Date: September
10, 2010 |
Definitions
This policy does not apply to facilities (hospitals,
surgery centers, kidney centers, etc…)
Modifier 80
Current Procedural Terminology (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).
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).
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).
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
Regence will reimburse 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. Regence
uses Milliman Care Guidelines in determining medical
necessity for assistant at surgery.
Modifier -AS must be used when the assistant at surgery
is a non-physician.
In the absence of a CMS assistant at surgery indicator,
Regence may establish an assistant at surgery designation.
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).
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.
The same multiple procedure fee reductions and clinical
edits apply to the assistant at surgery as the primary
surgeon.
When a provider reports an eligible procedure with
modifier -80 or -82 appended, reimbursement will be
20% of the established fee.
When a provider reports an eligible procedure with
modifier -81 or modifier -AS appended, reimbursement
will be 10% of the established fee.
References
CMS National Physician Fee Schedule Relative Value
File
American Medical Association. “Appendix A: Modifiers” Current
Procedural Terminology (CPT). AMA Press
Milliman. Milliman Care Guidelines
Cross References
None
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.
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