An assistant at surgery is a provider who actively assists the physician in charge of a case in performing a surgical procedure.
A physician, nurse practitioner, physician assistant or clinical nurse specialist who is authorized to provide such services under state law can serve as an assistant at surgery.
The "assistant at surgery" provides more than just ancillary services. The operative note should clearly document the assistant surgeon's role during the operative session.
Use the "80" modifier when the assistant at surgery service was provided by a physician.
Use the "81" This modifier pertains to physician’s services only. Minimal surgical assistance may be identified by adding the modifier 81 to the usual procedure code and describes an assistant surgeon providing minimal assistance to the primary surgeon.
Use the "82" modifier when a qualified resident surgeon is not available in a teaching facility:
The unavailability of a qualified resident surgeon is a prerequisite for use of this modifier and the service must have been performed in a teaching facility.
The circumstance explaining that a resident surgeon was not available must be documented in the medical record. This modifier is not intended for use by non-physician providers.
Use the modifier "AS" for assistant at surgery services provided by a physician's assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS). The provider must accept assignment.
Medicare reimburses services rendered for assistant at surgery by a physician performing as a surgical assistant at 16 percent of the Medicare Physician Fee Schedule Database (MPFSDB) amount.
Services rendered for assistant at surgery by non-physician providers (PA, NP, or CNS) are reimbursed at 85 percent of 16 percent (i.e., 13.6 percent) of the MPFSDB amount.
The Medicare physician fee schedule (MPFS)(JH) (JL) status indicators for assistant at surgery services should be used to determine if the procedure is allowed with the assistance of a second surgeon.
0 = Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
Note: Supporting documentation must be submitted at the time of claim submission to established medical necessity and should clearly document the assistant surgeon's role during the operative session.
1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.
2 = Payment restrictions for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.
9 = Concept does not apply
Documentation is required when modifiers 80, 81, 82 and AS modifiers are reported, and the payment indicator is a "0".
Documentation must provide a clinical picture of the patient and include:
The procedures or services performed and support the use of modifiers 80, 81, 82 and AS
The name of the assistant
Evidence the assistant surgeon actively participated in the procedure
Clearly document the assistant's role during the operative session:
Assistant's role provides more than ancillary services
Primary surgeon's signature:
The assistant is not required to sign the operative report, the primary surgeon's signature is sufficient
Modifier 82 requires the circumstance documented in the medical record that a resident surgeon was not available
Claims with modifiers 80, 81, 82 and AS should be submitted with required documentation following the Unsolicited Paperwork (PWK) process.
The PWK is a process allowing providers to submit documentation with an initial claim:
Claims will be rejected when reporting modifiers 80, 81, 82 and AS without supporting documentation. Rejected claims will need to be resubmitted using the instructions above for submitting documentation with your initial claim.
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