This was answered during the March 2013 Q&A Webinar. You may view the replay of this video, as well as all the replays from the past, read the transcripts and answer sheets when you join the CCO Club. For more information, click
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Here are some highlights that Laureen discussed.
Modifier 80 Assistant Surgeon
Modifier 80 identifies surgical assistant services and is applied to the surgical procedure code(s). Although this modifier is preferred by most payers to report an assistant surgeon, always monitor the explanation of benefits (EOBs) and maintain a list of carrier preferences.
Medicare and Modifier 80
Medicare restricts the use of modifier 80 to the primary procedure performed.
Modifier 81 Minimum Assistant at Surgery
Minimum surgical assistant services are identified by appending modifier 81 to the usual procedure code.
Modifier 82 Assistant Surgeon
Modifier 82 indicates that the procedure was performed requiring the presence of an assistant surgeon when a qualified resident surgeon was not available. In teaching hospitals, special requirements must be met to allow billing for an assistant surgeon, and modifier 82 is typically used in those instances. Check with your Medicare carrier for details. Box 19 on the CMS-1500 form can be used to type a message to indicate that a qualified resident surgeon was not available.
Modifier AS-Assistant at Surgery
Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery are identified by adding the HCPCS Level II modifier AS to the usual procedure code. This modifier may only be submitted with surgery codes, and additional documentation is required upon submission.
Be Aware of Limitations
CMS’ Guidelines 20.4.3—Assistant at Surgery Services (Rev. 1, 10-01-03) B3-15044 state: For assistant at surgery services performed by physicians, the fee schedule amount equals 16 percent of the amount otherwise applicable for the global surgery. Carriers may not pay assistants at surgery for surgical procedures in which a physician is used as an assistant at surgery in fewer than five percent of the cases for that procedure nationally. This is determined through manual reviews.
