Assistant Surgery (Surgical Assistant Services)
Customize your policy alerts
Sign up for all blue cross blue shield - kansas policy alerts
Know when blue cross blue shield - kansas releases new policies or updates existing guidance.
Monitor payer policy activity
Governs coverage and reimbursement for assistant surgeons (including physician assistants and advanced practice nurses) for surgical procedures performed in Kansas under BCBSKS, and explains pre/postoperative care and non-physician assistant payment rules.
No material clinical or coverage changes in this revision.
Coverage and Medical Necessity Criteria
Medical necessity coverage criteria
Covered when ALL of the following are met:
Use of more than one assistant surgeon requires individual consideration and documented medical necessity.
Contracting providers agree to accept the review process determination in such cases.
Pre/postoperative care rules
Preoperative and postoperative care:
If the itinerant surgeon arranges their own pre/postoperative care, payment responsibility is to the surgeon.
Non-physician assistant payment criteria
Non-physician assistant payment policy:
Registered nurses, Certified Surgical First Assistants, and other non-physicians are excluded from payment.
A signed waiver is required if the patient requests services knowing they may not be covered (see Policy Memo No. 1, Section X. WAIVER FORM).
See the BCBSKS provider manual online for the full list.
BCBSKS will not make payments for services performed by a registered nurse or other non-physicians assisting at surgery, including Certified Surgical First Assistants.
A list of procedures for which an assistant surgeon is not reimbursed is published online in the BCBSKS provider manual; the list is available at the BCBSKS provider publications URL referenced in the policy.
Services of an assistant surgeon may be considered not medically necessary — and benefits denied — when the assistant is not customarily required in conjunction with the surgical procedure. Denial of benefits follows BCBSKS review; if benefits are denied contracting providers agree to forgive charges to members unless the member was informed beforehand and signed a waiver requesting the service despite potential noncoverage.
Coding and Copyright
| No codes listed |
Provider Responsibilities, Billing, and Denial Risk
Medical necessity requirement for assistant surgery
Assistant surgery is covered when it is customarily required in conjunction with the surgical procedure because of medical necessity and would customarily be billed to the patient regardless of method of payment. Use of more than one assistant surgeon is reviewed on an individual basis and is covered only when medical necessity is substantiated. Contracting providers agree to accept BCBSKS review determinations regarding multiple assistants.
- Covered when customarily required and medically necessary
- Multiple assistant surgeons require individual substantiation of medical necessity
(Reserved)
Reserved for provider-action highlight.
Itemization of pre/postoperative services
When assistant surgeons provide preoperative and/or postoperative care for an itinerant (traveling) operating surgeon, those pre/postoperative services may be allowed in addition to the assistant surgery fee if clearly explained on the claim. Preoperative and postoperative services must be itemized separately from the assistant surgery fee. If the itinerant surgeon makes separate arrangements for pre/postoperative care, the assistant should look to the surgeon for payment.
- Itemize preoperative and postoperative services separately from assistant surgery fee
- Allow pre/postoperative services in addition to assistant fee when billed and explained for itinerant surgeons
Denial and member waiver
BCBSKS will pay only for assistants who are Physician Assistants or Advanced Practice Registered Nurses/Advanced Registered Nurse Practitioners licensed and authorized by Kansas law. BCBSKS does not pay for services of registered nurses or other non-physicians (including Certified Surgical First Assistants). Denial of benefits for assistant surgeon services is the result of the BCBSKS review process determination. Contracting providers agree to forgive charges to BCBSKS members when benefits are denied, except when the member has been informed that services may not be covered, requests the services, and signs a waiver permitting the charge (see Policy Memo No. 1, Section X. WAIVER FORM).
- Payments limited to PAs and APRNs/ARNPs licensed in Kansas
- No payment for registered nurses, Certified Surgical First Assistants, or other non-physicians
- Contracting providers must forgive member charges if benefits are denied by BCBSKS review
- Member may be charged if informed of noncoverage and signs a waiver (Policy Memo No. 1, Section X)
Background
Assistant surgery refers to services provided at the operating table by the surgical assistant and does not include mere availability to assist. Use of more than one assistant surgeon is allowed only with individual consideration and requires documentation substantiating medical necessity. BCBSKS limits payment for non-physician assistants to licensed Physician Assistants and Advanced Practice Registered Nurses/Advanced Registered Nurse Practitioners authorized by Kansas law; other non-physicians are excluded from payment.
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.