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Assistant Surgeon modifiers

  1. Question Assistant Surgeon modifiers
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    Will someone please help me understand the difference between Modifiers 80, 81, 82 and AS. I bill for assistants ranging from MD's, CNM's and First Assists. We have reimbursement problems with some CNM assist claims and a lot of problems with billing First Assist claims. Thanks.

  2. #2
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    I hope this helps.
    This is from the TrailBlazerhealth.com site. Search modifiers.


    Modifier Code: AS
    Update Date: 11/19/2008
    Category: Surgical
    Description: Physician Assistant (PA), Clinical Nurse Specialist (CNS) or Nurse Practitioner (NP) services for assistant-at-surgery.
    Guidelines: This modifier can only be used with surgical codes.

    The allowed amount for assistant-at-surgery services is 16 percent of the physician fee schedule. The allowable for the assistant-at-surgery services performed by an NP, PA or a CNS is 85 percent of the 16 percent allowed based on the physician fee schedule.

    The Medicare Physician Fee Schedule Database (MFSDB) will indicate whether coverage may be made for a specific procedure.

    Medicare will make payment for an assistant-at-surgery when the procedure is covered for an assistant and one of the following situations exists:
    The person reporting the service is a physician.
    The person bears the designation of PA, NP, nurse midwife or CNS.

    Physicians are prohibited from billing a Medicare beneficiary for assistant-at-surgery services for surgical procedures deemed non-covered for an assistant.

    Information regarding payment for assistant-at-surgery services guidelines is found at the following sites:

    CMS Pub. 100-04, Chapter 12, Section 20.4.3 and 40.8.D:
    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf





    Modifier Code: 80
    Update Date: 11/19/2008
    Category: Surgical
    Description: Assistant surgeon.
    Guidelines: This modifier can only be used with surgical codes.

    The allowed amount for assistant-at-surgery services is 16 percent of the physician fee schedule. The allowable for the assistant-at-surgery services performed by a Nurse Practitioner (NP), Physician Assistant (PA) or a Clinical Nurse Specialist (CNS) is 85 percent of the 16 percent allowed based on the physician fee schedule.

    The Medicare Physician Fee Schedule Database (MPFSDB) will indicate whether coverage may be made for a specific procedure.

    Modifier Code: 81
    Update Date: 11/19/2008
    Category: Surgical
    Description: Minimum assistant surgeon.
    Guidelines: This modifier can only be used with surgical codes.

    The allowed amount for assistant-at-surgery services is 16 percent of the physician fee schedule. The allowable for the assistant-at-surgery services performed by a Nurse Practitioner (NP), Physician Assistant (PA) or a Clinical Nurse Specialist (CNS) is 85 percent of the 16 percent allowed based on the physician fee schedule.

    The Medicare Physician Fee Schedule Database (MPFSDB) will indicate whether coverage may be made for a specific procedure.


    Modifier Code: 82
    Update Date: 11/19/2008
    Category: Surgical
    Description: Assistant surgeon (when qualified resident surgeon not available).
    Guidelines: This modifier can only be used with surgical codes.

    In a teaching hospital setting, when a non-physician practitioner is acting as an assistant-at-surgery and a qualified resident surgeon is not available, both the 82 and AS modifiers must be on the claim form.

    The allowed amount for assistant-at-surgery services is 16 percent of the physician fee schedule. The allowable for the assistant-at-surgery services performed by a Nurse Practitioner (NP), Physician Assistant (PA) or a Clinical Nurse Specialist (CNS) is 85 percent of the 16 percent allowed based on the physician fee schedule.

    The Medicare Physician Fee Schedule Database (MPFSDB) will indicate whether coverage may be made for a specific procedure.
    Ray Galvez CPC

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