Assistant Surgeon Modifiers Table
| Modifier | Definition | Approved Credential Types |
| 80 | assistant at surgery | This includes MD, DO, and DPM provider types and is an assistant surgeon providing full assist to the primary surgeon. |
| 81 | minimal assistant at surgery | This includes MD, DO, and DPM provider types and is an assistant surgeon providing minimal assistance to the primary surgeon. This modifier may be used when more than one assistant is involved or if one person assists during a portion of the surgery. This modifier is not intended for use by non-physician assistants (e.g., RN, PA). |
| 82 | assistant at surgery when a qualified resident surgeon is not available | This includes MD, DO, and DPM provider types. |
| AS | a non-physician assistant at surgery | This would include PA, CNS, CRNFA, RNFA, NP, LPN,DDS, DM. |
CMS Assistant Surgeon Payment Indicators
Surgical Assistants who are Physician Assistants, Nurse Practitioners, or Clinical Nurse Specialists should submit the identical procedure code(s) as the primary surgeon. Review this table for the CMS guideline to determine if the CPT code is eligible for reimbursement for an assistant at surgery.
| Payment Indicator | Definition | Denial Action |
| 0 | Assistant surgeon may be paid if supporting documentation is submitted to establish medical necessity. | Need to submit medical records. Documentation is key to reimbursement. |
| 1 | Statutory payment restriction for assistants at surgery applies to this procedure. Assistant surgeon may not be paid. | Adjust line item to EOB remark code. No further medical or appeal review required. |
| 2 | Payment restriction for assistant at surgery does not apply to this procedure. Assistant surgeons may be paid. | File Appeal or Reconsideration review with insurance carrier. |
| 9 | Assistant Surgeon Concept does not apply. | Assistant Surgeon Concept does not apply. |
How to Locate the Searchable Medicare Physician Fee Schedule
The searchable MPFS is located on the CMS website.
Tab 7, ASST SURG: this column indicates whether assistants at surgery may be paid. In the screenshot above, 2 is displayed, which means payment restriction for assistants at surgery does not apply to this procedure.
As private entities, third-party payers are able to establish their own rules and procedures. The potential variation in policy among insurance companies makes it imperative that practices contact each company to verify the specific payment and coverage policies for PAs. Even within the same insurance company, PA coverage policies can change slightly based on the particular plan that an individual or group has selected, the specific type of service being provided, and the state in which the service is delivered.
- CMS requires the PA to bill under their own name for surgical assistant claims.
- Check commercial plan billing requirements for PA surgical assistant.
Examples of Reductions from the Published MPFS Amount
- Assistants at surgery receive 16% of the MPFS rate.
- Nurse practitioners, physician assistants, and clinical nurse specialists are paid 85%.
- This is NextGen RCM Services’ opinion as to how these instructional payer guidelines should be applied. Coding is ultimately the responsibility of the provider of services; provider approval must be obtained before any claim or claims can be entered or modified.