CurrentBlue Cross Blue Shield - WisconsinPolicy C-08006

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

Defines reimbursement rules for assistant surgeon services billed with modifiers 80, 81, 82, and AS for Blue Cross Blue Shield - Wisconsin commercial plans; aligned to CMS MPFS assistant surgery indicators.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

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

Policy CodePolicy C-08006

Change TypeNo material change

Effective DateSep 27, 2023

Next Review Date

Key ActionReimbursement allowed only when procedures have MPFS Assistant Surgery payment indicator '2' and only one assistant surgeon is reimbursed per covered procedure.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Only oneassistant surgeon reimbursable per covered procedure

Indicator 2codes reimbursable

Indicators 0/1/9codes non-reimbursable

16% / 14%Modifier AS reimbursement

MPFSAlignment

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.

Assistant Surgeon Coverage Criteria

Assistant surgeon coverage criteria

Covered when ALL of the following are met:

Assistant surgeon reimbursement allowed when the surgical procedure has MPFS Assistant Surgery payment indicator = 2.

Only one assistant surgeon will be reimbursed per covered surgical procedure.

Eligible services are billed with one of the assistant surgeon modifiers: 80, 81, 82, or AS, unless provider, state, or federal contracts or requirements indicate otherwise.

Assistant at surgery must bill the same procedure code(s) as the primary surgeon, except when the primary surgeon bills an obstetric global code; in that case the assistant bills the specific surgery code with the appropriate modifier.

Modifier AS reimbursement percentage varies by state and fee schedule: generally 16% of the allowance; Missouri 16%; Wisconsin 14% of the physician and physician extender fee schedules.

Assistant surgeon services are not reimbursable for procedures that only require positioning or retraction for visualization.

Codes identified with MPFS Assistant Surgery payment indicators 0, 1, or 9 are non-reimbursable (indicator 0 may require documented medical necessity or be subject to restrictions/mandates).

An applicable assistant surgeon modifier billed inappropriately may lead to denial or recovery of payment.

Modifiers, Codes, and Payment Indicators

Assistant Surgeon Modifiers — Covered/PaymentModifierCovered

80	Physician providing assistance in surgery — reimbursed at 16% of the allowance.
81	Physician providing minimum assistance in surgery — reimbursed at 16% of the allowance.
82	Physician providing assistance in surgery when qualified resident not available — reimbursed at 16% of the allowance.

Non‑Physician Assistant Modifier — Regional VariationModifier

AS	Non-physician providing assistance in surgery — reimbursed at 16% of the applicable physician extender fee schedule; if no applicable physician extender fee schedule, reimbursed at 16% of the applicable physician fee schedule. Wisconsin-specific rate: 14% (see exemptions).

MPFS Assistant Surgery payment indicators

MPFS Assistant Surgery payment indicator = 2Reimbursable — codes identified with payment indicator '2' are eligible for assistant surgeon reimbursement (only one assistant surgeon allowed per covered surgical procedure).

MPFS Assistant Surgery payment indicators = 0,1Not reimbursable — payment restrictions apply; assistants at surgery are not paid unless supporting documentation establishes medical necessity (0) or statutory restriction applies (1).

MPFS Assistant Surgery payment indicator = 9Not applicable — assistant surgeon concept does not apply.

Provider Billing and Reimbursement Actions

Billing Rule

Assistant surgeon reimbursement authorization and billing rules

Reimbursement is allowed for an assistant surgeon only when the surgical procedure is eligible under the Medicare Physician Fee Schedule assistant surgery payment indicators and is billed with an assistant surgeon modifier (80, 81, 82, or AS). Only codes identified with MPFS Assistant Surgery payment indicator '2' are reimbursable; codes with indicators '0', '1', or '9' are non‑reimbursable. Only one assistant surgeon will be reimbursed per covered surgical procedure.

Bill the same procedure code(s) as the primary surgeon (unless the primary surgeon bills an OB global code; then bill the specific surgery code with the appropriate assistant modifier).
Ensure the procedure’s MPFS assistant surgery payment indicator = 2 before billing for an assistant surgeon.
Do not bill assistant surgeon modifiers for procedures that only require positioning or retraction for visualization; such services are non‑reimbursable.
Only one assistant surgeon modifier/payment is allowed per covered procedure.

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.

ScopeIncludes both physician and non‑physician practitioners who provide active intraoperative assistance to the primary surgeon.

Billing noteAssistant at surgery should bill using the same procedure code(s) as the primary surgeon unless the primary surgeon bills an obstetric global code; then the assistant bills the specific surgery code with appropriate modifier.

MPFS Assistant Surgeon Payment Indicators

Indicator 2Restriction does not apply — assistant surgeon may be paid.

Indicator 0Payment restriction applies unless supporting documentation is submitted to establish medical necessity.

Indicator 1Statutory payment restriction applies — assistant surgeon may not be paid.

Indicator 9Assistant surgeon concept does not apply to this procedure.