Reimbursements

Category:

Assistant at Surgery

Reimbursement Policy: NDRP-Surg-01
Topic: Surgery
Effective Date: July 1, 2018
Last Reviewed:
April 1, 2019

Description:

This policy addresses reimbursement for covered assistant at surgery procedures.

Definitions:

An assistant at surgery is a physician, nurse practitioner, physician assistant or other qualified practitioner who actively assists the physician in charge of a case in performing a surgical procedure.

Assistant at surgery services are required for the successful completion of certain surgical procedures that have been identified as sufficiently complex or intensive.

Policy:

BCBSND will reimburse 20 percent of the fee schedule amount otherwise applicable for the global surgery, for assistant at surgery services performed by a physician, physician assistant (PA), certified registered nurse practitioner (CRNP) or certified nurse mid-wife (CNM).

Note: Modifier 80, 81, or 82 must be appended to the claim line when reporting assistant at surgery performed by a physician, other than a physician who performs and bills for another surgical procedure during the same operative session.

Modifier AS must be appended to the claim line when reporting assistant at surgery performed by an employed PA, CRNP or CNM.  The allowed amount for these services is equal to 17% of the fee schedule amount.  (Fee Schedule Amount x 85%) x 20%.  Under the legacy system, procedures billed with a modifier AS were paid at 15% of the Fee Schedule amount.

Payment will also be made for assistant at surgery performed by an independent practicing CRNP, if applicable, when it appended with the AS modifier.

Cross-Reference:

For a list of the codes that are eligible for Assistant at Surgery, please refer to the 2018 Assistant at Surgery List, published as a part of the July 2018 Fee Schedule Update.