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Tricare/HealthNet- Modifier 80

ARCPC9491

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When billing for a PA for assist at surgery - we use modifier AS ... codes billed same as way as surgeon (as long as assist is allowed of course) but when we bill this to insurance (Tricare specifically and I had one VA Premier patient today....) they tell us they don't recognize the AS modifier and to use 80. However, as well all know, 80 mod is for MD's... not for PA's... so I'm a little confused... and I don't remember this ever being an issue until now... it's rather strange... so I was thinking since these are PA's (and can't be credentialed...(as far as know w/ these plans)...that since we will billing under the MD's numbers...AS would "kick out" because it's billed w/ MD's numbers...thus causing a conflict...but they tell us no, that's not it, they just don't recognize it...

insight...thoughts...anyone?? :confused:
 

thythaot

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Portland, Oregon
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Cpc -a

I thought that might be help

• CPT Modifier -80, assistant at surgery. This includes MD, DO, and DPM provider types and is an assistant surgeon providing full assist to the primary surgeon.

• HCPCS Level II modifier -AS, a non-physician assistant at surgery. This would include PA, CNS, CRNFA, RNFA, NP, LPN, DDS, DMD, and surgical technician provider types, subject to contract eligibility.

Also, you can check on the website of CMS for refer to the Medicare Physician Fee Schedule database (MPFSDB).
http://www.cms.hhs.gov/PFSlookup/.

Good luck
:)
 

RebeccaWoodward*

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North Carolina
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AR~

I find this becomes carrier specific rather than traditional coding guidelines. We, also, have one carrier that does not recognize AS for PA's. They will only accept modifier 80.
 

todd5400

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AR

We have also been told by Tricare to bill under the PA name with 80 modifier and have done it this way for several years as per their instructions. This is the hard part of billing for NPP's because it is so carrier specific.

Mary, CPC
 
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