Wiki modifier 80 with 43235 and 49084

[Kaydeen]

We have a claim with 43235 and 49084 with modifier 80. The insurance is stating that 80 can not be used on these codes we can not find an information on the codes with the 80 modifier.
Help please. Thanks, Kaydeen

 

[thomas7331]

The Medicare physician fee schedule assigns an assistant surgeon indicator to all codes which indicates whether or not an assistant can be paid. The indicator for both of these codes is '1', which is defined as "payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid" so the payer is giving you correct information on this. Most payers follow the Medicare code indicators, but some will create their own lists of codes for which an assistant is allowed.

You can find more about how to get this information on the physician fee schedule section of the CMS web site:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html

 

[Kaydeen]

thank you Thomas