Assistant Surgeon

An “assistant surgeon” is a physician who assists another physician during a surgical procedure. The services of an assistant surgeon are payable when the following guidelines are met:

1. The complexity of the surgery requires an assistant. Surgical procedures that generally do not require the services of an assistant surgeon include endoscopies, angiograms, and minor surgeries such as incision and drainage of abscesses and most cataract extractions; and
2. The facility does not have a resident or training program; or
3. The facility has a resident or training program, but a resident or intern on staff is not available to assist the surgeon. In this case, modifier 82 should be used to indicate no resident was available.

Where applicable, the reasonable charge for the services of an assistant surgeon may not exceed 20 percent of HMSA’s Maximum Allowable Fee (MAC).

Claims Filing Information

Procedure codes describing the surgical procedures performed should be indicated on the claim.

If the surgery does not usually require the services of an assistant surgeon, please include a copy of the operative report or other narrative explaining the complexity of the surgery and why the services were needed.

Coordination with the Primary Surgeon

The assistant surgeon’s charges should be filed separately from the claim for the primary surgeon’s services. When filing a claim for an assistant surgeon’s charges, be sure the surgical procedure code and diagnosis code are consistent with those on the claim filed by the primary surgeon. You may also wish to coordinate the submission of your claim with the primary surgeon. If your claim is received before the surgeon’s claim, the processing of your claim may be delayed.

Modifier Codes

Please use one of the following modifier codes as appropriate:

80

Assistant Surgeon: Surgical assistant services may be identified by adding the modifier 80 to the usual procedure number(s).

81

Minimum Assistant Surgeon: Minimum surgical assistant services are identified by adding the modifier 81 to the usual procedure number.

82

Assistant Surgeon (when qualified resident surgeon not available): The unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure number(s).

Physician’s Assistant (PA) or Nurse Practitioner Acting as Assistant Surgeon

When an appropriately licensed physician’s assistant (PA) acts as an assistant surgeon, the claims should be filed using the surgical procedure code and modifier code AS.

Where applicable, the reasonable charge for the services of a Physician Assistant or Nurse Practitioner acting as an assistant surgeon may not exceed 17 percent of HMSA’s Maximum Allowable Fee (MAC).

Revision History