Currentblue cross blue shield - kansasPolicy N/A

Assistant Surgery (Surgical Assistant Services)

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.

Policy Summary

Payerblue cross blue shield - kansas

PolicyAssistant Surgery (Surgical Assistant Services)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionDocument medical necessity when requesting coverage for more than one assistant surgeon and itemize pre/postoperative services when applicable.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

coveredAssistant surgery coverage stance

percentage-basedReimbursement method

PAs & APRNsEligible non-physician assistants

online listExceptions location

Coverage and Medical Necessity Criteria

Medical necessity coverage criteria

Covered when ALL of the following are met:

Covered conditions: The assistant surgery is customarily required in conjunction with the surgical procedure because of medical necessity; it would customarily be billed to the patient regardless of method of payment.

Use of more than one assistant surgeon requires individual consideration and documented medical necessity.

Multiple assistants: Use of more than one assistant surgeon is subject to individual consideration and covered only upon substantiation of medical necessity.

Contracting providers agree to accept the review process determination in such cases.

Pre/postoperative care rules

Preoperative and postoperative care:

Policy Summary

Payerblue cross blue shield - kansas

PolicyAssistant Surgery (Surgical Assistant Services)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionDocument medical necessity when requesting coverage for more than one assistant surgeon and itemize pre/postoperative services when applicable.

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.

Non-physician assistant payment criteria

Non-physician assistant payment policy:

Who is payable: BCBSKS will pay only for Physician Assistants and Advanced Practice Registered Nurses/Advanced Registered Nurse Practitioners who are licensed and authorized by Kansas law.

Registered nurses, Certified Surgical First Assistants, and other non-physicians are excluded from payment.

Denial and member waiver: Denial of benefits for assistant surgeon services is determined through the BCBSKS review process; if benefits are denied, contracting providers must forgive charges to members unless the member signed a waiver after being informed the services may not be covered.

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).

Procedures excluded list: A list of procedures for which an assistant surgeon is not reimbursed is published online at the BCBSKS provider manual link.

See the BCBSKS provider manual online for the full list.

Provider Responsibilities, Billing, and Denial Risk

Documentation Required

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

Note

(Reserved)

Reserved for provider-action highlight.

Billing Rule

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 Risk

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)

Definitions

Assistant surgery — definition and scope

DefinitionAssistant surgery: services provided at the operating table by the surgical assistant; mere availability to assist does not constitute assistant surgery.

ScopeLimited to services rendered at the operating table during the surgical procedure.

Multiple assistantsUse of more than one assistant is allowed only with documented medical necessity and individual consideration.

Exclusions noteDoes not include preoperative or postoperative services unless separately itemized and allowed under itinerant surgeon rules.

Non-physician assistant eligibility and payment

Payable non-physician typesBCBSKS will pay only for Physician Assistants (PAs) and Advanced Practice Registered Nurses/Advanced Registered Nurse Practitioners (APRNs/ARNPs) licensed and authorized by Kansas law.

Excluded non-physiciansRegistered nurses, Certified Surgical First Assistants, and other non-physicians are not eligible for assistant surgeon payments.

Denial and waiverIf BCBSKS denies benefits for assistant surgeon services, contracting providers must forgive charges unless the member signed a waiver after being informed the services may not be covered.

Reference for procedure exceptionsA list of procedures for which an assistant surgeon is not reimbursed is posted online at the BCBSKS provider manual link.

OpenPayer

Assistant Surgery (Surgical Assistant Services)

Coverage and Medical Necessity Criteria

Coding and Copyright

Provider Responsibilities, Billing, and Denial Risk

Background

Definitions