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PAP511

CPT Modifiers 80, 81, 82 and AS


Provider Administrative Policy

Section
Physician
Policy Date
November 2007
Status/Date
Revised/March 2009
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

CPT Modifiers 80, 81, 82 and AS

Use modifiers 80, 81, 82 or AS with a surgical procedure code to indicate an assisted surgery. If the assistant was a physician (M.D. or D.O.), you may use either modifier 80 or 82 on the claim submitted. Use modifier 81 or AS when the assistant involved with the procedure is not a physician (i.e., physician assistant (PA), nurse practitioner (NP), or certified surgical assistant as described in PAP247 ). Non-physician assistants listed as “Other Clinical Staff,” are not eligible for separate reimbursement (i.e., surgical scrub technician).

A physician assisting on a surgery must submit a claim for his or her own service using his/her individual NPI number on a CMS 1500 claim form.  If Blue Cross of Idaho approves the procedure for assistant surgeon reimbursement, we will reimburse 20 percent of the maximum procedural allowance or the fee billed, whichever is less.

A non-physician assisting on a surgery must also submit a claim for his or her own service using his/her individual NPI number on a CMS 1500 claim form. If Blue Cross of Idaho approves a procedure for non-physician assistant reimbursement, we will reimburse 10 percent of the maximum procedural allowance or the fee billed, whichever is less.

If there are multiple surgical procedures, Blue Cross of Idaho will follow the bundling guidelines and apply the appropriate benefit level (10 percent or 20 percent) for the surgical assist if allowed. There are no benefits available for more than one assistant during a procedure. 

Reimbursement Policy
The Centers for Medicare & Medicaid Services (CMS) designate which procedures warrant the need of a surgical assistant and publish the following indicators in the National Physician Fee Schedule Relative Value File (NPFSRVF). Blue Cross of Idaho follows these CMS designations.

Assistant surgeon may be paid with documentation
1Assistant surgeon cannot be paid
2Assistant surgeon can be paid
Assistant surgeon concept does not apply 

Codes with a CMS assistant at surgery indicator of "0" may be eligible for reimbursement for an assistant at surgery upon review of the operative report.

Policy History

Date Action Reason
March 2009 Revised Assistant surgical procedures clarified
May 2008 Revised Title change

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