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Regence BCBSO Reimbursement Policy

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:  October 2013 Last Revised:  October 2013

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

Our health plan 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. Our health plan uses MCG in determining medical necessity for assistant at surgery.

In the absence of a CMS Assistant at Surgery Indicator, we may establish an assistant at surgery designation.

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, clinical nurse specialist, registered nurse first assist (RNFA) or certified registered nurse first assist (CRNFA). 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 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

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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