Assistant At Surgery
An assistant actively helps the primary surgeon. The modifier depends on who assists and the circumstances.
- 80: assistant surgeon
- 81: minimum assistant surgeon
- 82: assistant surgeon when a qualified resident is not available (teaching settings)
- AS: physician assistant, nurse practitioner or clinical nurse specialist acting as assistant
Payment And Eligibility
Medicare pays a physician who assists at surgery 16 percent of the fee schedule amount for the procedure. Non-physician practitioners billing with AS are paid 85 percent of that amount. Each procedure's assistant-at-surgery indicator in the fee schedule shows whether an assistant is never paid, paid with documentation of medical necessity, or always payable.
Co-Surgeons
Co-surgery is two surgeons, usually of different specialties, each performing a distinct part of a single procedure. Each surgeon bills the same code with modifier 62 and is paid 62.5 percent of the fee schedule amount. The co-surgeon indicator for the code must allow it, and each surgeon's operative note must describe the portion they performed.
Team Surgery
Highly complex procedures that require a team of surgeons may be reported with modifier 66. Payment is determined by the MAC on a case-by-case basis when the fee schedule indicator permits it, and documentation of each surgeon's role is required.
Frequently Asked Questions
- Can a surgical first assistant who is not a PA or NP bill Medicare?
- Medicare does not recognize registered nurse first assistants or surgical technologists as separate billing providers. Their services are part of the facility payment.
- Should co-surgeons submit claims at the same time?
- It helps. The MAC processes both claims against the same procedure, and inconsistent codes or modifiers between them are a common cause of denial.
Billing Support For This Specialty
Physicians Professional Billing Services, Inc. has billed wound care, surgical and procedural specialties since 1998, across every Medicare Part B MAC jurisdiction.
Primary Sources
This page is general information about billing and coverage rules and is not legal, coding or reimbursement advice for a specific claim. Coverage policies change; confirm current requirements with CMS and the applicable Medicare Administrative Contractor.