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Reimbursement Policies & Guidelines

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Assistant Surgeon Modifiers 80, 81, 82 and AS

Effective Date: May 10, 2016

Purpose:
To implement the appropriate reimbursement for surgical procedures billed by physicians, physician assistants, nurse practitioners and clinical nurse specialists with the assistant at surgery modifiers 80, 81, 82, or AS. These assistant at surgery modifier procedures, according to CMS guidelines, are subject to the assistant at surgery policy which can aid in future cost avoidance for HNJH.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

Scope:
All products are included, except
  • Products where Horizon NJ Health is secondary to Medicare (e.g. Medigap).
  • COB

Policy:
Procedures billed by the physician assistants, nurse practitioners and clinical nurse specialists, with the assistant at surgery physician modifiers 80, 81, 82, or AS are subject to the assistant at surgery reimbursement of 16 percent of the fee schedule amount applicable for the surgical payment. For assistant at surgery services performed by physicians billed with modifiers 80, 81, 82 or AS, the reimbursement amount equals 16 percent of the fee schedule amount applicable for the surgical payment.

The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. In the event of such changes, the Policy will continue to be in force, albeit applied to the new or amended coding so issued until such time as the Policy is reviewed and updated to reflect the new or amended coding.

Procedure:
Procedures billed with the assistant at surgery physician modifiers 80, 81, 82, or the AS modifier for physician assistants, nurse practitioners and clinical nurse specialists, are subject to the assistant at surgery reimbursement of 16 percent of the fee schedule amount applicable to the surgical payment. For assistant at surgery services performed by physicians billed with modifiers 80, 81, 82 or AS, the reimbursement amount equals 16 percent of the fee schedule amount applicable for the surgical payment.

Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:

  • Group or Individual benefit
  • Provider Participation Agreement
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
  • Mandated or legislative required criteria will always supersede.