Priority Health follows CMS guidelines when determining if CPT code is eligible for reimbursement for an assistant at surgery.

• Some services are not reimbursed for assistant surgeon services (identified by co-surgeon indicator "0" - see CMS link below).
• Some services are reimbursed for assistant surgeon services only if documentation supports medical necessity (identified by co-surgeon indicator "1" - see CMS link below).
• Documentation may be requested to support the need for an assistant surgeon.
• The multiple procedure fee reduction applies the same way to an assistant at surgery as it would apply to the primary surgeon.
• Indicating that a resident was not available is not sufficient support for reimbursing some assistant surgeon services.

CMS guidelines

Modifier use

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.

CPT Modifier -81, minimal assistant at surgery.

This includes MD, DO, and DPM provider types and is an assistant surgeon providing minimal assistance to the primary surgeon. This modifier may be used when more than one assistant is involved or if one person assists during a portion of the surgery. This modifier is not intended for use by non-physician assistants (e.g., RN, PA).

CPT Modifier -82, assistant at surgery when a qualified resident surgeon is not available to assist the primary surgeon.

This includes MD, DO, and DPM provider types.

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.