CurrentHighmark Blue Cross Blue Shield WnyPolicy G-06005

Assistant at Surgery Modifiers (80, 81, 82, AS)

Reimbursement policy governing when and how assistant surgeon services billed with modifiers 80, 81, 82, or AS are eligible for payment for Highmark BCBS Medicaid Managed Care (MMC), HARP, and Child Health Plus (CHPlus) members.

Policy Summary

PayerHighmark Blue Cross Blue Shield Wny

PolicyAssistant at Surgery Modifiers (80, 81, 82, AS)

Policy CodePolicy G-06005

Change TypeTitle update and review

Effective DateDec 19, 2023

Next Review Date

Key ActionBill eligible procedures with modifier 80, 81, 82, or AS as applicable; failure to bill an applicable modifier appropriately may result in denial.

SourceLink

POLICY UPDATE CHANGES

12/19/2023 — Review approved and effective; policy title updated.

20%typical reimbursement % (Modifiers 80, 82, AS)

16%reimbursement % (Modifier 81)

1assistant surgeons reimbursed

MMC, HARP, CHPlusprograms covered

Reimbursement Criteria for Assistant at Surgery

Covered when ALL of the following conditions are met:

Applies to MMC, HARP, and CHPlus members only (program applicability).

Eligible procedure is billed with an appropriate assistant-at-surgery modifier (80, 81, 82, or AS).

If an applicable modifier is not billed appropriately, the procedure may be denied.

Reimbursement is limited to one assistant surgeon per eligible procedure.

When multiple procedures are performed and only some are eligible for assistant reimbursement, assistant services will be considered only for the eligible procedures; multiple procedure fee reductions and clinical edits apply to both assistant and primary surgeon.

Policy Summary

PayerHighmark Blue Cross Blue Shield Wny

PolicyAssistant at Surgery Modifiers (80, 81, 82, AS)

Policy CodePolicy G-06005

Change TypeTitle update and review

Effective DateDec 19, 2023

Next Review Date

Key ActionBill eligible procedures with modifier 80, 81, 82, or AS as applicable; failure to bill an applicable modifier appropriately may result in denial.

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 Allowed Assist Count

Assistant at Surgery ModifiersModifierCovered

80	Denotes an assistant at surgery providing full assistance to the primary surgeon. Reimbursement is based on 20% of the allowable fee for the primary surgeon.
81	Denotes an assistant at surgery providing minimal assistance to the primary surgeon. Reimbursement is based on 16% of the allowable fee for the primary surgeon.
82	Denotes an assistant at surgery when a qualified resident surgeon is not available to assist the primary surgeon. Reimbursement is based on 20% of the allowable fee for the primary surgeon.
AS	Denotes an assistant at surgery who is a non-physician (physician assistant, nurse practitioner or clinical nurse specialist). Reimbursement is based on 20% of the allowable fee for the primary surgeon.

Allowed assist count

Allowed assist countOne assistant surgeon reimbursed per eligible procedure when billed with an applicable modifier (80, 81, 82, or AS).

Multiple proceduresWhen multiple procedures are performed, only assistant services for procedures eligible for assistant reimbursement will be considered; same multiple procedure fee reductions and clinical edits apply to assistant and primary surgeon.

Billing requirementIf an applicable assistant-at-surgery modifier is not billed appropriately, the procedure may be denied.

Billing and Submission Requirements

Billing Rule

Assistant Surgeon Modifier Billing — bill eligible procedures with modifier 80, 81, 82, or AS

Bill eligible procedures with modifier 80, 81, 82, or AS as applicable. If an applicable modifier is not billed appropriately, the procedure may be denied.

Modifiers: 80 (full assistance), 81 (minimal assistance), 82 (when qualified resident not available), AS (non-physician assistant).
Reimbursement is applied to one assistant surgeon per eligible procedure and follows multiple procedure fee reductions and clinical edits.
Assistant should report the same procedure codes as the primary surgeon unless the primary surgeon bills a global code; then the assistant may bill the specific surgery code with the appropriate modifier.

Modifier Definitions

Modifier 80

Modifier 80 - definitionDenotes an assistant at surgery providing full assistance to the primary surgeon.

ReimbursementReimbursement for services reported with modifier 80 is based on 20% of the allowable fee for the primary surgeon.

ApplicabilityUsed when an assistant provides full operative assistance and should be billed on the eligible procedure; failure to bill appropriately may result in denial.

Modifier 81

Modifier 81 - definitionDenotes an assistant at surgery providing minimal assistance to the primary surgeon.

ReimbursementReimbursement for services reported with modifier 81 is based on 16% of the allowable fee for the primary surgeon.

Use caseApply when the assistant's role is limited/minimal during the procedure and bill the appropriate modifier with the procedure code.

Modifier 82

Modifier 82 - definitionDenotes an assistant at surgery when a qualified resident surgeon is not available to assist the primary surgeon.

ReimbursementReimbursement for services reported with modifier 82 is based on 20% of the allowable fee for the primary surgeon.

Billing noteUse when a qualified resident is unavailable; assistant must bill the eligible procedure with modifier 82 to be considered for reimbursement.

Modifier AS

Modifier AS - definitionDenotes an assistant at surgery who is a non-physician (physician assistant, nurse practitioner, or clinical nurse specialist).

ReimbursementReimbursement for services reported with modifier AS is based on 20% of the allowable fee for the primary surgeon.

ScopeApply when a non-physician assistant provides operative assistance and bill the eligible procedure with modifier AS as applicable.