CurrentPremera BluecrossPolicy N/A

Assistant Surgeons (Physician) — reimbursement for assistant-at-surgery modifiers

Defines when the Plan recognizes and reimburses physician assistant-at-surgery modifiers (80, 81, 82) and modifier AS for non-physician assistants, and sets reimbursement rates and documentation requirements for providers across Premera lines of business.

Policy Summary

PayerPremera Bluecross

PolicyAssistant Surgeons (Physician) — reimbursement for assistant-at-surgery modifiers

Policy CodePolicy N/A

Change TypeReimbursement rate update and billing clarifications

Effective DateNov 1, 2025

Next Review DateN/A

Key ActionWhen billing as an assistant surgeon, report the same procedure code as the primary surgeon with the appropriate assistant modifier and include your own NPI; only one assistant modifier is allowed per procedure.

SourceLink

POLICY UPDATE CHANGES

Effective with dates of service on and after November 1, 2025, reimbursement for assistant surgeon modifiers 80 and 82 changes from 20% to 16% of the provider's applicable Fee Schedule allowed amount for the primary surgery.

Alaska exception: reimbursement of modifiers 80 and 82 will remain 20% for services with dates of service through February 5, 2026; effective February 6, 2026 Alaska reimbursement will change to 16%.

Only one assistant surgeon modifier is allowed per applicable surgical procedure; co-surgeons should use modifier 62 and each must document and submit their own operative report.

Assistant surgeon must report same procedure code as primary surgeon appended with appropriate assistant-at-surgery modifier; assistant must submit own NPI on claim.

16%new reimbursement rate for modifiers 80 and 82 (effective 11/01/2025)

20% until 02/05/2026

Policy Summary

PayerPremera Bluecross

PolicyAssistant Surgeons (Physician) — reimbursement for assistant-at-surgery modifiers

Policy CodePolicy N/A

Change TypeReimbursement rate update and billing clarifications

Effective DateNov 1, 2025

Next Review DateN/A

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.

Assistant Surgeon Coverage Criteria

Assistant surgeon coverage criteria

Covered when ALL of the following conditions are met:

Assistant surgeon eligibility is determined primarily by the Assistant Surgeon indicator in the current CMS National Physician Fee Schedule; only codes flagged as eligible will be reimbursed unless medical necessity documentation is submitted for Indicator 0 procedures.

For procedures with a National Physician Fee Schedule Assistant Surgeon indicator of 0, documentation supporting the need for a surgical assistant and the specific services rendered must accompany the claim.

The assistant surgeon must report the same procedure code as the primary surgeon appended with an appropriate assistant-at-surgery modifier; if the primary surgeon bills a global code, the assistant may bill the specific surgery-only code. The assistant must submit their own NPI on the claim.

Only one assistant surgeon modifier is allowed per applicable surgical procedure. When two surgeons act as primary surgeons performing distinct or simultaneous parts of the same procedure, they are co-surgeons and must use modifier 62 with each surgeon submitting a separate operative report.

Recognized modifiers: 80, 81, 82 for physician assistants acting as assistant-at-surgery; modifier AS for non-physician assistants (PA, NP, CNS). Modifiers 80/81/82 must not be billed with modifier AS by the same provider on the same claim/date of service.

Reimbursement rates: effective for dates of service on or after November 1, 2025, qualified assistant surgeon reimbursement (modifiers 80 and 82) is 16% of the primary surgery Fee Schedule allowed amount (previously 20%). Minimum assistant surgeon reimbursement is 10% of the primary surgery Fee Schedule allowed amount. Alaska exception: modifiers 80 and 82 remain 20% for services with dates of service through February 5, 2026; effective February 6, 2026 Alaska reimbursement will change to 16%.

Modifiers, Eligible Procedures, and Coding Rules

Assistant/Co-surgeon/Team ModifiersModifier

80	Physician assistant-at-surgery modifier (assistant surgeon)
81	Physician assistant-at-surgery modifier (assistant surgeon)
82	Physician assistant-at-surgery modifier (assistant surgeon)
AS	Assistant at surgery for non-physician (physician assistant, nurse practitioner, clinical nurse specialist)
62	Two surgeons (co-surgeons)
66	Surgical team

Assistant surgeon eligibility

Eligibility sourceOnly procedure codes flagged as eligible for assistant surgeons per the CMS National Physician Fee Schedule Assistant Surgeon indicator will be reimbursed.

Indicator 0 exceptionFor procedures with NPFS Assistant Surgeon Indicator = 0, documentation of the need for a surgical assistant and the specific services rendered must accompany the claim to support reimbursement.

Claim submission requirementAssistant must report only the procedures they assisted on, using the same procedure code as the primary surgeon (or surgery-only code if primary billed global), appended with an appropriate assistant-at-surgery modifier and the assistant's own NPI on the claim.

Single-assistant limitOnly one assistant surgeon modifier is allowed per applicable surgical procedure; multiple assistants should be billed as a surgical team (modifier 66) or as co-surgeons (modifier 62) when appropriate.

Billing, Documentation, and Operational Rules

Billing Rule

Allowed modifiers and exclusivity

Only one assistant surgeon modifier is allowed per applicable surgical procedure. When the assistant is a physician, do not bill modifiers 80, 81, or 82 together with modifier AS (non-physician assistant) on the same claim, by the same provider, or for the same date of service. If multiple physicians or specially trained personnel are required and functioning as a surgical team, use modifier 66 (Surgical Team) and ensure each provider's documentation defines their role. When two surgeons act as primary surgeons performing distinct or simultaneous parts of a procedure, they are co-surgeons and should append modifier 62; each co-surgeon must submit a separate operative report identifying the other as a co-surgeon.

Only one assistant surgeon modifier (80, 81, 82, or AS) may be billed per procedure.
Modifiers 80, 81, 82 are for physician assistants acting as assistant-at-surgery; modifier AS is for non-physician assistants (PA, NP, CNS).
Do not append physician assistant modifiers (80/81/82) with modifier AS on the same claim/date of service by the same provider.
Co-surgeons use modifier 62 and must each submit their own operative report documenting distinct roles.
Use modifier 66 for a surgical team; each team member must document their role.

Key Definitions

Assistant Surgeon — definition

DefinitionAssistant Surgeon: provides full assistance to the primary surgeon and is capable of taking over the surgery if the primary surgeon becomes incapacitated.

ReportingThe assistant reports their services using their own provider NPI and the appropriate place of service on the claim.

Reimbursement (qualified)Effective 11/01/2025 reimbursement for assistant surgeon (when qualified) is 16% of the provider's applicable Fee Schedule allowed amount for the primary surgery (previously 20%).

Minimum Assistant Surgeon — definition and reimbursement

DefinitionMinimum Assistant Surgeon: an assistant who does not participate in the entire procedure but provides minimal assistance to the primary surgeon.

Reporting