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Billing for Assistant Surgeon

  1. #1
    Default Billing for Assistant Surgeon
    Medical Coding Books
    We are large academic facility and bill surgeries utilizing the 80 and 82 modifiers. Can someone tell me if you reduce your usual fee for the assistant surgeons or do you bill as normal and let the modifier dictate your reimbursement?


  2. #2
    Default Billing for Assist on Surgeries
    Most practices I have come across tend to bill anywhere from 10% to 20% of the surgeons fee for the assistant. Hope that helps. Have a great day!
    Susan Ward, CPC, COC, CPC-I, CEMC, CPCD, CPRC
    AAPC ICD-10 Expert Trainer

    A small act of kindness a day can make someone's day special

  3. #3
    Our facility bills with the fee at 25% of the surgeon. That has haunted us on occasion as some payors think, and pay, like the amount billed is the same amount for the surgeon so they reduce reimbursement accordingly only they've reduced the reimbursement on the already reduced fee. It's rare but it happens if they're not locating the surgeon's claim first.

  4. #4
    We billed at the same rate for the assistant surgeon and let the insurance company reduce the rate of the assistant surgeon. This is what I was told to do at a few differant billing workshops put on by the insuance companies.

    Tammy F

  5. Default
    I work for an insurance company and when a surgery requires an assistanct surgeon, the plan allowance for the assistant surgeon is 16% of the allowance for the surgery. You can bill the rate for the asst surgeon and we will reduce the rate accordingly.

    mbane, cpc

  6. Default Caroline B.
    We bill the same for the asst. surg and let the insurance company reduce and pay the asst portion.

  7. #7
    Wichita, KS
    Never reduce your fee. Let the insurance company do that for you. If you reduce before hand, they will reduce that even more.

  8. #8
    Each insurance company handles assistant surgery differently. Most however have a fee schedule allowance for the surgical procedure itself. The assistant surgery fee is typically anywhere from 16 to 25% of the surgery fee schedule. So if a fee schedule allowance is $1000 for the surgeon, the assist would be paid at 16%, or $160. So long as your charge for the assistant never dips below the percentage of the surgeon's fee schedule amount, you're fine. I used to import the fee schedule from the insurer into excel and setup a formula to calculate the assist fee. Whenever I noticed our charges dipping below payment, I would recommend increasing the chargemaster for that code.

  9. Default Assistant Surgeon
    We bill same amount as main surgeon and allow the insurance comapnies adjust down - usually 16% of allowable.

    Kris N

  10. #10
    If you bill the same for an assistant surgeon as the primary if the assistant is nonparticipating with the patient's insurance company you will be sticking the patient with an exorbitant fee for an assistant that they will have to pay OOP when balance billed.

    Insurance companies base the rate off the assistant modifier, billing appropriately less for the assistant will not reduce the payment you receive from the insurance company.

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