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Guidelines for Assistant Surgeon Claims

Blue Cross and Blue Shield of Alabama provides coverage for assistant surgeons for many procedures. An assistant surgeon may be considered medically necessary when the complexity of the operation necessitates the primary surgeon have additional "skilled" operative assistance from another surgeon or a licensed non-physician practitioner.

Payment is made at 25 percent of the allowance for the surgical procedure when a physician is the assistant. Claims for a physician assisting in surgery should be filed with type service 0 and modifier 80, 81 or 82. Use of modifier is required for proper payment.

Reimbursement for physician assistants (PAs), nurse practitioners (NPs) and surgical assistants (SAs) is 70 percent of the 25 percent of the allowed amount for the surgical procedure. Claims for a PA, NP or SA assisting in surgery should be filed with type service 0 and modifier AS. Use of modifier is required for proper payment.

For additional procedures performed during the same operative session, major- minor processing guides apply. Add-on procedure codes are not reduced to half guides.

Additionally, there may be times when a physician elects to utilize more than one assistant during the operative session. Blue Cross will reimburse only one assistant per operative session.

Some services are included in the primary physician or facility reimbursement and are not separately reimbursable. The following is not inclusive, but provides examples of services included in the primary reimbursement.

Proper documentation to support separate reimbursement of assistant surgeon claims includes the following:

Click here to view the medical policy on the related topic of “Co-Surgeons and Team Surgeons.”

Last Updated April 2012