CurrentMVP Health CarePolicy N/A

Assistant-at-surgery reimbursement for select CPT/HCPCS codes

This policy governs MVP Health Care's reimbursement for assistant-at-surgery services performed by physicians, physician assistants, nurse practitioners, and clinical nurse specialists for a long enumerated list of procedure codes, with Medicare-only distinctions for some codes.

Policy Summary

PayerMVP Health Care

PolicyAssistant-at-surgery reimbursement for select CPT/HCPCS codes

Policy CodePolicy N/A

Change TypeNo material change

Effective DateEffective July 2019

Next Review DateN/A

Key ActionWhen medical documentation supports extenuating circumstances, MVP may reimburse for assistant-at-surgery services when performed by physicians, physician assistants, nurse practitioners and clinical nurse specialists for the services listed.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

manyprocedure codes listed as eligible for assistant-at-surgery reimbursement

Medicare-onlycodes marked with an asterisk

Jul 2019policy effective date as written

Assistant-at-Surgery Coverage Criteria

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.

Medical documentation must support extenuating circumstances to qualify for assistant-at-surgery reimbursement.

Assistant-at-surgery services must be performed by one of the following: physicians, physician assistants, nurse practitioners, or clinical nurse specialists.

The service must be one of the procedures listed in the policy's enumerated codes to be eligible for reimbursement.

Codes marked with an asterisk are covered by Medicare only; all other listed codes are covered across all product lines.

Applicable CPT/HCPCS Codes

Example T-codes with mappingsmixedCovered

0051T	List of component codes mapped (e.g., 19303, 20924*, 21142, 21245, 21431, 21810, 22548, 22848, 23155)
0078T	List of component codes mapped (e.g., 19304, 20937, 21143, 21246, 21432, 21825, 22551, 22849, 23156)

Enumerated CPT codes (partial)CPTCovered

23472	Included among many standard CPT codes eligible for assistant-at-surgery reimbursement
24100*	Example of a code marked Medicare-only

Medicare-only indicator (inv-04):

Medicare-only indicatorCodes marked with an asterisk are covered by Medicare only; all other codes listed are covered by all product lines.

Example of Medicare-only marked codes12018*, 12047*, 12057* (asterisk indicates Medicare-only coverage)

Scope of applicabilityApplies to the enumerated procedure codes listed in the policy when assistant-at-surgery services are performed.

Provider Billing & Documentation Actions

Prior Authorization

Reimburse assistant-at-surgery only with documented extenuating circumstances

MVP may reimburse for assistant-at-surgery services when medical documentation supports extenuating circumstances and the service is performed by a physician, physician assistant, nurse practitioner, or clinical nurse specialist.

Require clear medical documentation that explains the extenuating circumstances justifying an assistant-at-surgery.
Reimbursement is limited to the services listed in the policy when those circumstances are documented.

Definitions and Notes

Reimbursement for assistant-at-surgery services when medical documentation supports extenuating circumstances (inv-06):

DefinitionMVP may reimburse for assistant-at-surgery services when medical documentation supports extenuating circumstances.

Providers coveredPhysicians, physician assistants, nurse practitioners, and clinical nurse specialists may perform reimbursable assistant-at-surgery services when criteria are met.

ConditionReimbursement is contingent on medical documentation demonstrating extenuating circumstances for the listed services.

Codes listed with an asterisk (inv-07):

Meaning of asteriskCodes listed with an asterisk are covered by Medicare only.

Contrast with other codesAll other codes listed without an asterisk are covered by all MVP product lines.

Example codes24100* and 23172* are examples of codes marked with an asterisk in the document.