Reimbursements

Category:

Assistant at Surgery

Reimbursement Policy: NDRP-Surg-01
Topic: Surgery
Effective Date: July 1, 2018
Last Reviewed:
September 19, 2019

Description:

This policy provides guidelines for the reimbursement of services provided by an Assistant Surgeon.

 

Definitions:

Modifier
Description
80 Assistant Surgeon
81 Minimum Assistant Surgeon
82 Assistant Surgeon (when qualified resident surgeon not available)
AS Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS) services for Assistant at Surgery

 

Policy:

An assistant surgeon actively assists the primary surgeon performing a surgical procedure. Assistant surgeons submit the identical procedure code(s) as the primary surgeon, with the appropriate modifier appended (80, 81, 82, or AS) to represent their service(s).

The reimbursement amount is dependent upon the assistant surgeon modifier appended to the surgical code(s) submitted. Only one assistant surgeon will be reimbursed for each eligible procedure(s).

Modifier Reimbursement Percentage
80 20% of the fee schedule
81 20% of the fee schedule
82 20% of the fee schedule
AS 17% of the fee schedule (Fee Schedule Amount x 85%) x 20%

 

Note: Multiple procedure reductions may apply if an assistant at surgery submits multiple procedure codes. Refer to the Multiple Surgeries Reimbursement Policy for additional information.

 

Procedure Codes Eligible for Assistant Surgeon Reimbursement:

The assistant at surgery procedure code eligible list is developed based on the Center for Medicare & Medicaid Services (CMS) Physician Fee Schedule (PFS) Relative Value Unit (RVU) File status indicators. All codes in the CMS PFS RVU File with the status indicator “2” for “Assistant at Surgery” are reimbursable for assistant at surgery services, when indicated by an assistant surgeon modifier (80, 81, 82, or AS).

CMS Definition for Assistant Surgery Status Indicator
2 Payment restriction for assistant at surgery does not apply to this procedure. Assistant at surgery may be paid.

 

Limitations and Exclusions:

While reimbursement is considered, payment determination is subject to, but not limited to:

  • Group or Individual benefit
  • Provider Participation Agreement
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
  • Mandated or legislative required criteria will always supersede.

In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.

 

Cross-Reference:

CMS PFS RVU File

Multiple Surgeries

 

History:

Date Updates
9/19/19 Added CMS status indicators, Limitations and Exclusions, Disclaimer and History.

 


Disclaimer

Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.