My area of the world requires AS for non-practioners. The only exception is Medicaid...they do require 80. Below are a couple of our main carriers.
Medcost=Adjustment for Charges Made by an Assistant Surgeon:
Charges by credentialed MD assistant surgeons will be limited to 20% of the
MedCost allowable amount unless your contract states otherwise. Credentialed non-MDs will be limited to 14% of the MedCost allowable amount unless your contract states otherwise. Charges for assistant surgeons are not allowed unless the presence of an assistant surgeon is necessary due to the complexity of the procedure or the condition of the patient. To assure accurate repricing, MedCost requests that all providers file assistant surgeon charges with the full surgeon rate, applying the 80, 81, 82, or AS modifiers. MedCost will determine the allowable expense based on the policy and procedures in place for the modifier and provider of service billed. Please note: MedCost only reprices the claim. The claim administrator makes payment consideration for assistant surgeon charges based on the plan design.
UHC=Assistant surgeons who are not physicians should submit the identical procedure code(s) as the primary surgeon with the following modifier to represent their service(s):
Modifier HCPCS Level II Description
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
BCBS NC=Billing/Coding/Physician Documentation Information
This policy may apply to the following codes. Inclusion of a code in this section does not guarantee that it
will be reimbursed. For further information on reimbursement guidelines, please see Administrative Policies
on the Blue Cross Blue Shield of North Carolina web site at www.bcbsnc.com. They are listed in the Category
Search on the Medical Policy search page.
Co-Surgeon modifiers are -62 or -66.
Assistant surgeon modifiers are -80,-81, or -82.
Physician assistant modifier is -AS.
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