CurrentAnthemPolicy C-08006

Modifiers 80, 81, 82 and AS: Assistant at Surgery - Professional

Defines Anthem's reimbursement rules for assistant-at-surgery services billed with modifiers 80, 81, 82, or AS and identifies eligible procedures based on CMS MPFS Assistant Surgery payment indicators; applies to commercial lines where not preempted by provider, state, or federal contracts.

Policy Summary

PayerAnthem

PolicyModifiers 80, 81, 82 and AS: Assistant at Surgery - Professional

Policy CodePolicy C-08006

Change TypeNon-material wording update

Effective Date04/01/2026

Next Review Date

Key ActionEnsure services meet authorization and medical necessity guidelines and submit assistant-at-surgery claims with the appropriate modifier when the procedure has MPFS indicator '2'.

SourceLink

POLICY UPDATE CHANGES

Updated language to follow CMS MPFS Assistant Surgery Indicators and removed reference to ACS reimbursement guidelines; updated policy title from Assistant Surgeon Services.

1assistant surgeon allowed per covered surgical procedure

MPFS '2'codes reimbursable for assistant surgeon

MPFS '0/1/9'codes nonreimbursable for assistant surgeon

16%allowance percentage referenced

Assistant Surgeon Coverage Criteria

Assistant surgeon coverage criteria

Assistant surgeon reimbursement is determined by the CMS MPFS Assistant Surgery payment indicator and proper use of assistant surgeon modifiers (80, 81, 82, AS); services are subject to contract, medical necessity, and billing rules.

ALL of the following

Procedure is identified with MPFS Assistant Surgery payment indicator '2' (payment restriction does not apply; assistant surgeon may be paid).
The service is billed with an appropriate assistant surgeon modifier: 80, 81, 82, or AS.
No provider, state, or federal contract or requirement overrides reimbursement for the assistant surgeon service.

ANY of the following

Policy Summary

PayerAnthem

PolicyModifiers 80, 81, 82 and AS: Assistant at Surgery - Professional

Policy CodePolicy C-08006

Change TypeNon-material wording update

Effective Date04/01/2026

Next Review Date

Key ActionEnsure services meet authorization and medical necessity guidelines and submit assistant-at-surgery claims with the appropriate modifier when the procedure has MPFS indicator '2'.

SourceLink

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Procedure is identified with MPFS Assistant Surgery payment indicator '0', '1', or '9' (0 = payment restriction unless medical necessity documented; 1 = statutory restriction; 9 = concept does not apply).

Procedure requires only assistance for positioning or retraction for maintaining visualization.

An applicable assistant surgeon modifier is billed inappropriately (billing error).

ALL of the following

Only one assistant surgeon will be reimbursed per covered surgical procedure.
Procedures reported with an assistant surgeon modifier are subject to multiple surgery reimbursement rules.
The assistant at surgery should not report procedure codes different from the primary surgeon, except when the primary surgeon bills an obstetric global code; in that case the assistant may bill the specific surgery code with the appropriate modifier.

ALL of the following

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis and to the member's state of residence; reimbursement is subject to provider/state/federal contracts.

ALL of the following

Assistant surgeon reimbursement and allowance are applied per the related coding guidance (see MPFS indicators and assistant surgeon modifier comments for allowance percentage).

ALL of the following

An assistant surgeon should not bill a different procedure code than the primary surgeon except as noted above; inappropriate use of assistant modifiers may result in nonreimbursement.

ALL of the following

Assistant Surgeon: a physician or non-physician practitioner who actively assists the physician in charge of the case in performing a surgical procedure.
MPFS Assistant Surgeon payment indicator: 0 = payment restriction (needs supporting documentation); 1 = statutory restriction (assistant may not be paid); 2 = no restriction (assistant may be paid); 9 = concept does not apply.

Coding and Allowance for Assistant Surgeon Services

Reimbursable CPT/HCPCS Codes (Assistant Surgeon allowed)mixedCovered

MPFS Assistant Surgery Indicator = 2

Payment restriction for assistants at surgery does not apply to this procedure; assistant surgeon may be paid.

Not Reimbursable / Restriction appliesmixedNot Covered

MPFS Assistant Surgery Indicator = 0	Payment restriction for assistants at surgery applies unless supporting documentation is submitted to establish medical necessity.
MPFS Assistant Surgery Indicator = 1	Statutory payment restriction for assistants at surgery applies; assistant surgeon may not be paid.
MPFS Assistant Surgery Indicator = 9	Assistant surgeon concept does not apply.

Modifier Codes (billing guidance)Modifier

80	Physician providing assistance in surgery. Use when a physician assistant surgeon assisted. Typical allowance: approximately 16% of the primary procedure allowance (MPFS assistant surgeon practice).
81	Physician providing minimum assistance in surgery. Typical allowance: approximately 16% of the primary procedure allowance.
82	Physician providing assistance in surgery when qualified resident not available. Typical allowance: approximately 16% of the primary procedure allowance.
AS	Non-physician assistant at surgery. Reimbursed under the applicable physician extender fee schedule at approximately 16% of the primary procedure allowance; if no applicable extender fee schedule exists, reimbursement occurs under the applicable physician fee schedule.

Assistant Surgeon Allowance Percentage

Assistant Surgeon AllowanceApproximately 16% of the primary procedure allowance (MPFS assistant surgeon practice).

Authorization, Documentation, and Billing Rules

Prior Authorization

Authorization and medical necessity

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis and to the member's state of residence; reimbursement is also subject to provider, state, or federal contracts and requirements.

Billing Rule

Multiple surgery billing rule for assistant surgeon services

Procedures billed with an assistant surgeon modifier are subject to multiple surgery reimbursement rules; an applicable assistant surgeon modifier billed inappropriately will result in nonreimbursement.

Assistant should not report procedure codes different from the primary surgeon except when the primary bills an OB global code; then the assistant bills the specific surgery code with the appropriate modifier.

Definitions

Assistant Surgeon — definition

DefinitionAn assistant at surgery is a physician or non-physician practitioner who actively assists the physician in charge of the case in performing a surgical procedure.

Who may servePhysicians or non-physician practitioners (as defined) who actively assist during the operative procedure.

Role descriptionProvides intraoperative assistance to the primary surgeon as part of the surgical team.

MPFS Assistant Surgeon payment indicator — meaning

Indicator = 2No payment restriction; assistant surgeon may be paid (codes with MPFS Assistant Surgery payment indicator '2' are reimbursable).

Indicator = 0Payment restriction applies unless supporting documentation is submitted to establish medical necessity (may limit reimbursement).

Indicator = 1Statutory payment restriction; assistant surgeon may not be paid for procedures with this indicator.

Indicator = 9Assistant surgeon concept does not apply to this procedure (not eligible for assistant-at-surgery reimbursement).

Policy Revision History

2026-04-01effective_date

Policy effective date updated to 04/01/2026.

2026-01-01review_date

Policy last reviewed on 01/01/2026.

2024-04-01revisionLatest

Updated language to follow CMS MPFS Assistant Surgery Indicators, removed reference to ACS reimbursement guidelines, changed CMS alignment from 'reimbursement' to 'identification', updated policy title and Definitions and Related Policies sections, and removed Assistant Surgery coding list.