CurrentFlorida BluePolicy 10-027

Surgical Assistant

Defines Florida Blue reimbursement rules for billing assistant-at-surgery services (including assistant surgeon, RNFA, PA/NP/CNS roles) on CMS-1500 or equivalent claims and who is affected (providers billing Florida Blue).

Policy Summary

PayerFlorida Blue

PolicySurgical Assistant

Policy CodePolicy 10-027

Change TypeNo material changes

Effective Date01/15/2009

Next Review Date

Key ActionDo not submit appeals to override this policy; in teaching hospitals report modifier 82 and document that no qualified resident was available.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

ACS 2023primary source for procedure eligibility

Modifier 82 requiredteaching hospital rule

Cesarean onlydelivery eligibility

Medical reviewmultiple assistants

Assistant-at-Surgery Coverage Criteria

Covered when ALL of the following rules are met:

ALL of the following

Use the American College of Surgeons (ACS) 2023 Study as the primary source to determine whether a procedure is eligible for an assistant-at-surgery (ACS designations: almost always; almost never; sometimes).
If ACS designation is 'sometimes' or silent
- Use the CMS Medicare Physician Fee Schedule (MPFS) to determine eligibility.
- Reimburse assistant surgeon services only when the MPFS assistant-at-surgery column status indicator is '2'.

Policy Summary

PayerFlorida Blue

PolicySurgical Assistant

Policy CodePolicy 10-027

Change TypeNo material changes

Effective Date01/15/2009

Next Review Date

Key ActionDo not submit appeals to override this policy; in teaching hospitals report modifier 82 and document that no qualified resident was available.

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.

Allowed Codes, Modifiers, and MPFS Status

Allowed Modifiers and HCPCSModifier | HCPCS

80	Assistant Surgeon modifier (assistant surgeon services identified by adding modifier 80)
81	Minimum Assistant Surgeon modifier (minimum assistant services identified by adding modifier 81)
82	Assistant Surgeon modifier when qualified resident not available (use when teaching hospital resident unavailable)
HCPCS - PA/NP/CNS	HCPCS entries for physician assistant, nurse practitioner, or clinical nurse specialist services as assistant at surgery

MPFS assistant-at-surgery status

Policy when ACS designation is 'sometimes' or silentFlorida Blue uses the CMS Medicare Physician Fee Schedule (MPFS) to determine assistant-at-surgery eligibility and will reimburse only assistant surgeon services that have an MPFS assistant-at-surgery column status indicator of '2'.

Primary source otherwiseIf ACS designation is not 'sometimes' or silent, the American College of Surgeons (ACS) 2023 Study is used as the primary source to determine assistant-at-surgery eligibility (designations: almost always; almost never; sometimes).

Applicability over hospital bylawsThe MPFS/ACS criteria determine reimbursement regardless of hospital bylaws that may require an assistant at surgery.

AppealsAppeals to override this MPFS/ACS-based determination will not be accepted.

Authorization, Documentation, and Appeals

Denial Risk

No Appeals; Teaching-Hospital Modifier 82 and Documentation Required

Appeals to override this policy will not be accepted. In teaching hospitals, assistant-at-surgery services will not be reimbursed unless no qualified resident was available and that fact is certified in the medical record; report modifier 82 when applicable.

Do not submit an appeal seeking an override of this assistant-at-surgery policy — appeals will not be accepted.
For services in a teaching hospital, ensure the medical record contains certification that no qualified resident was available; report modifier 82 on the claim when that certification exists.

Definitions and Special Teaching-Hospital Rule

Assistant role definition

Active assistance requirementAn assistant must actively assist the operating physician in the actual performance of the surgical procedure and be unavailable to perform another surgical procedure at the same time.

Operative note documentationThe operative note should clearly document the assistant's role during the operative session.

Scope of participationAssistant participation refers to involvement in the surgical procedure itself, not ancillary services.

Teaching hospital rule

Reimbursement condition in teaching hospitalsAssistant-at-surgery services in teaching hospitals will not be reimbursed unless no qualified resident was available to perform the services.

Documentation requirementThe unavailability of a qualified resident must be certified in the medical record.

Modifier to reportReport modifier 82 when reimbursement is allowed because no qualified resident was available.