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Modifier AS: Physician assistant, nurse practitioner, or clinical nurse Hello Everyone, We seem to be having a problem with our assistant surgeon charges being denied from Tricare. We use Physician Assistants for our assistant surgeons. So we have been using modifier AS ( with the appropriate RT or LT ). We keep receiving denials stating 053: Surgical Assistant Surgeon services will be eligible for reimbursement under the applicable physician fee schedule at 14% of the allowance for the primary procedure. Coding Chart Assistant Surgery Coding Chart Assistant Surgeon not allowed Exemptions There are no exemptions to this policy. Policy History 06/01/2019 New policy template Surgeon General, Deputy Surgeon General, Assistant Surgeons General and to active duty Regular Corps officers of the Commissioned Corps of the U.S. Public Health Service who hold the Permanent Director grade (O-6).

Humana assistant surgeon policy

This policy applies to professional providers. Assistant Surgeon Indicator "2" is “2 = Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.” Procedure codes with a CMS assistant surgeon indicator of “0” are NOT eligible for assistant surgeon reimbursement upon initial adjudication of the claim. Policy Name Page 2 of 2 An Assistant Surgeon actively assists the physician performing a surgical procedure. Modifier 80: Assistant surgeon. Modifier 81: Minimum assistant surgeon.

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Reimbursement for Assistant-at-Surgery services, when reported by the Same Individual Physician or Other Qualified Health Care Professional, is based on whether the As\ sistant Surgeon is a Physician $designated by modifiers 80, 81 or 82$ or another Health Care Professional $designated by modifier AS$ acting as the surgical assistant.

Please see the Attachment section for the state defined list Physicians (MD/DO) 2016-08-01 Per TRICARE policy, Humana Military is required to review and implement claim auditing software to ensure correct code processing on claims. As claims process, the coding is compared to the National … Assistant-at-Surgery Policy Page 3 of 10 UnitedHealthcare Oxford Reimbursement Policy Effective 01/01/2021 ©1996-2021 Oxford Health Plans, LLC Oxford will not reimburse independently submitted services by a non-contracted, health care practitioner (other than 2021-01-01 2020-07-31 2008-10-24 Military Spouse Employment Partnership (MSEP) Humana Military is a proud partner of MSEP which helps military spouses find rewarding work through partnerships with national companies who agree to allow the military spouse the option of taking their job with them when they move to a new duty station. An assistant at surgery is a physician who actively assists the physician in charge of a case in performing a surgical procedure. (Note that a nurse practitioner (NP), physician assistant (PA) or clinical nurse specialist (CNS) who is authorized to provide such services under state law can also serve as an assistant at surgery).

Team Surgery 11/13/18: The AS modifier should be reported by Nurse Midwives, Physician Assistants & Nurse Practitioners when performing surgical services as an Assistant Surgeon. Nurse Midwives should bill the SB modifier for non-surgical services. Policy created to reflect most current clinical evidence per Medical Policy Steering Committee. 2019-10-01 Subject: Assistant Surgeon Services .
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2019-11-20 medical policy. When Co-Surgeon, Assistant Surgeon, Team Surgeon and Physician Assistant/Nurse Practitioner/Nurse Midwife services will be considered for payment Co-Surgeons Services by surgeons of different specialties or subspecialties each performing distinct components of a procedure as primary surgeons will be allowed at 120% of the maximum the assistant surgeon 16% allowable rate. As of 07/01/2019 dates of service registered nurse/first assistants are reim-bursed as assistant surgeons at a rate equal to 85% of the assistant surgeon 14% allowable rate. Co-Surgery Co-surgery is reimbursed at 62.5% of the fee schedule/allowable amount. Team Surgery 11/13/18: The AS modifier should be reported by Nurse Midwives, Physician Assistants & Nurse Practitioners when performing surgical services as an Assistant Surgeon.

This is the ninth edition of Physicians as Assistants at Surgery, a study first undertaken in 1994 by the American College of Surgeons and other surgical specialty organizations. The study reviews all procedures listed in the “Surgery” section of the American Medical Association’s Current 2020 Procedural Terminology (CPT TM). The operation is of sufficient difficulty and complexity to require an assistant surgeon; and; The assistant surgeon must actively assist in the surgery: To "actively assist" means that the assistant surgeon must assist in the actual performance of the surgical procedure. Also, the assistant surgeon, in the event the surgeon is unable to continue, should be able to complete the surgery. Humana Claim Payment Policy Updates.
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Assistant Surgeon Policy Page 2 of 4 UnitedHealthcare Oxford Reimbursement Policy Effective 02/01/2018 ©1996-2018 Oxford Health Plans, LLC REIMBURSEMENT GUIDELINES Multiple Procedures If an Assistant Surgeon submits multiple procedure codes, multiple procedure reductions will apply. Refer to the Multiple Procedures policy. Cesarean Section

Wife has a PPO through her employer. Emergency surgery in January. Gas passer (surprisingly) in network. On staff at the hospital. Assistant surgeon was non-par. Billed the carrier $6400 .

Modifier 82: Assistant surgeon (when qualified resident surgeon not available).