CPT Modifier 82
Description:
Assistant surgeon (when qualified resident surgeon not available)
Guidelines/Instructions:
Submit CPT modifier 82 to identify services of Assistant surgeon (when qualified resident surgeon not available)
The unavailability of a qualified resident surgeon is a prerequisite for submitting CPT modifier 82 with a surgical procedure code.
This modifier may only be submitted with surgery codes.
No additional documentation is required with the claim when CPT modifier 82 is submitted.
Documentation must be maintained in the patient's medical record:
A statement that no qualified resident was available to perform the service, or
A statement indicating that exceptional medical circumstances exist, or
A statement indicating the primary surgeon has an across the board policy of never involving residents in the preoperative, operative or postoperative care of his/her patients.
To determine whether the services of an assistant surgeon may be submitted to Medicare with CPT modifier 82, refer to the Medicare Physician Fee Schedule database (MPFSDB).
Access the database directly from the CMS Web site at
http://www.cms.hhs.gov/PFSlookup/.
Select Physician Fee Schedule Search from the left area of the Web page.
Screen defaults to current year. Under Type of Information, select Payment Policy Indicators, then “next.”
On the “select field options” screen, select “Next.”
Enter the procedure code and select “All Modifiers”, then click “Submit.”
Refer to the column heading “Asst Surg.”
Indicator 0 = Payment restriction for assistants at surgery applies to this procedure. Supporting documentation describing the medical necessity for an assistant surgeon must be submitted with the claim.
Indicator 1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistants at surgery will not be paid.
Indicator 2 = Payment restriction for assistants at surgery does not apply to this procedure. Assistants at surgery may be paid.
Indicator 9 = Concept does not apply (the most likely explanation is that the procedure is not a surgery).
Reference:
CMS Pub. 100-04, chapter 12, sections 20.4.3, 40.8.D, 100.1.7: teaching hospital requirements:
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
CMS Pub. 100-04, chapter 23, in the Addendum following section 90:
http://www.cms.hhs.gov/manuals/downloads/clm104c23.pdf