Oncology & Hematology Coding Alert

Answer: Working in a teaching hospital does not affect the physician assistants (PA) reimbursement in terms of the services that are provided. Modifier -80 (assistant surgeon) is defined in the CPT as surgical assistant services may be identified by adding the modifier -80 to the usual procedure number(s). Your specific question regarding modifier -80, however, does not apply to Medicare policy in this situation. Currently, Medicare does not recognize a technical surgical assistant (TSA) for bone marrow harvesting in the operating room. To bill and be paid under Medicare policy, the procedure must be approved for TSA, which would then require using modifier -80 to identify that you were providing surgical assistance for that procedure.

It is common practice in bone marrow transplant programs to use physician/PA teams. Payers may be willing to look at negotiated rates if one can demonstrate improved efficiency or outcomes by using a physician/PA team.

Medicare policy is very specific, but many third-party payers and private programs may be more amenable regarding negotiated payment using
modifier -80.

Editors note: This question was answered by Ron Nelson, PA-C, president of Health Services Associates in Michigan, and a representative of the AMA-CPT Advisory Committee for the American Academy of Physician Assistants.