CurrentBaylor Scott & White Health PlanPolicy 248

Assistant Surgeon Policy

Governs when assistant surgeon services are eligible for reimbursement under Baylor Scott & White Health Plan, using CMS NPFS assistant surgeon payment indicators; applies to all lines of business unless otherwise indicated and affects billing providers seeking payment for assistant at surgery services.

Policy Summary

PayerBaylor Scott & White Health Plan

PolicyAssistant Surgeon Policy

Policy CodePolicy 248

Change TypeRoutine review — no material changes

Effective DateFeb 1, 2025

Next Review DateJan 13, 2026

Key ActionBill assistant surgeon services only for CPT codes with CMS NPFS indicator '2' and include an appropriate assistant surgeon modifier (80, 81, 82, or AS).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Indicator '2'Reimbursable indicator

'0','1','9'Not eligible indicators

80,81,82,ASAccepted modifiers

Not applicablePrior authorization

Assistant Surgeon Reimbursement Eligibility

Eligibility criteria for assistant surgeon reimbursement

BSWHP follows CMS NPFS assistant surgeon indicators to determine reimbursement eligibility.

Follow CMS NPFS assistant surgeon payment policy indicators to determine reimbursement eligibility for assistant surgeon services.

ALL of the following

CPT codes with CMS NPFS assistant surgeon indicator '2' are considered reimbursable for assistant surgeon services when billed with an appropriate assistant surgeon modifier (80, 81, 82, AS).indicator = '2'
Procedure codes with CMS assistant surgeon indicator '0' are not eligible for assistant surgeon reimbursement upon initial adjudication but may be reviewed for reimbursement upon written appeal with submission of supporting documentation demonstrating medical necessity.indicator = '0'

Policy Summary

PayerBaylor Scott & White Health Plan

PolicyAssistant Surgeon Policy

Policy CodePolicy 248

Change TypeRoutine review — no material changes

Effective DateFeb 1, 2025

Next Review DateJan 13, 2026

Key ActionBill assistant surgeon services only for CPT codes with CMS NPFS indicator '2' and include an appropriate assistant surgeon modifier (80, 81, 82, or AS).

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Modifiers and CMS NPFS Indicator Guidance

Accepted assistant surgeon modifiersModifierCovered

80	Assistant surgeon
81	Minimum assistant surgeon
82	Assistant surgeon (when qualified resident surgeon not available)
AS	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery

CMS NPFS Assistant Surgeon Indicator

CMS NPFS Assistant Surgeon indicator '2''2' = Payment restriction for assistants at surgery does not apply; assistant at surgery may be paid (reimbursable).

Indicator '0'Not eligible for reimbursement on initial adjudication; may be reviewed for reimbursement upon written appeal with supporting documentation demonstrating medical necessity.

Indicators '1' and '9'Not eligible for assistant surgeon reimbursement.

Billing, Authorization, and Appeals

Prior Authorization

Prior Authorization and Non-contracted Providers

Prior Authorization: Not applicable for covered assistant surgeon services per this policy. Non-contracted practitioners seeking payment as an assistant surgeon (billing with modifiers 80, 81, 82, or AS) will NOT be reimbursed unless Prior Authorization for that provider has been procured.

Prior Authorization is NOT required for in-network assistant surgeon services.
Non-contracted practitioners seeking payment as an assistant surgeon must obtain Prior Authorization to be eligible for reimbursement.

Denial Risk

Appeal for Indicator 0 Codes

Procedures with a CMS assistant surgeon indicator of '0' are not eligible for assistant surgeon reimbursement on initial adjudication. Claims for these procedures may be reviewed for reimbursement only upon written appeal when supporting documentation demonstrating medical necessity for the assistant surgeon is submitted.

CMS assistant surgeon indicator '0' — Not eligible on initial claim; eligible for review only via written appeal with supporting documentation.
CMS assistant surgeon indicators '1' and '9' — Not eligible for assistant surgeon reimbursement.

Billing Rule

Documentation/Billing Modifier Requirement

Assistant surgeon services must be billed with the appropriate assistant surgeon modifiers (80, 81, 82, AS) as applicable. BSWHP follows CMS NPFS assistant surgeon payment indicators to determine reimbursement eligibility; CPT codes with indicator '2' are considered reimbursable when billed with the appropriate assistant surgeon modifier. The following provider types are not eligible for reimbursement of assistant at surgery service: Certified First Assistant (CFA); Certified Surgical First Assistant (CSFA); Certified Surgical Assistant (CSA).

Bill assistant surgeon services with modifiers: 80, 81, 82, or AS as applicable.
CPT codes with CMS assistant surgeon indicator '2' — considered reimbursable when billed with an assistant surgeon modifier.
Provider types not eligible for reimbursement: CFA, CSFA, CSA.

Terms and Modifier Definitions

Assistant Surgeon — definition

DefinitionAn Assistant Surgeon actively assists the physician performing a surgical procedure.

Reimbursement basisAssistant surgeon services are reimbursed only for CPT codes with CMS NPFS indicator '2' and when billed with an accepted assistant surgeon modifier (80, 81, 82, AS).

ExclusionsCertified First Assistant (CFA), Certified Surgical First Assistant (CSFA), and Certified Surgical Assistant (CSA) are not eligible for reimbursement for assistant at surgery services and are not recognized by Medicare for this service.

Assistant surgeon modifiers

Modifier 80Assistant surgeon.

Modifier 81Minimum assistant surgeon.

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

Modifier ASPhysician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery.