CurrentUnitedHealthcarePolicy N/A

Assistant-at-Surgery reimbursement

Defines UnitedHealthcare's reimbursement policy for Assistant-at-Surgery services billed on CMS-1500 (and UB-04 when specified), including who may be reimbursed, applicable modifiers, and payment percentages.

Policy Summary

PayerUnitedHealthcare

PolicyAssistant-at-Surgery reimbursement

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit accurate claims on CMS-1500 or electronic equivalent; only one assistant per eligible procedure is reimbursable and use appropriate assistant modifiers.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

16%Physician assistant reimbursement (of Allowable Amount)

14%Health Care Professional reimbursement (of Allowable Amount)

1Assistants allowed per procedure

NPFS 2Eligibility indicator

Assistant-at-Surgery Coverage Criteria

Related Billing Codes

59618-ROUTINE-OBSTETRIC-CARE-INCLUDING-ANTEPARTUM-CARE-CESAREAN

CPT 59618: Routine Obstetric Care Including Cesarean Delivery After Attempted Vaginal Birth

765-OPHTHALMIC-ULTRASOUND-DIAGNOSTIC-BSCAN-AND-QUANTITATIVE

CPT 765: Ophthalmic Ultrasound with B-Scan and Quantitative A-Scan

0722-THIS-CPT-CODE-IS-NOT-VALID-OR-DOES-NOT-EXIST-IN-THE-CURRENT

CPT 0722: Invalid or Nonexistent CPT Code

0765-MAGNETIC-RESONANCE-IMAGING-BONE-MARROW-BLOOD

CPT 0765: Magnetic Resonance Imaging of Bone Marrow Blood Supply

766-ULTRASOUND-CHEST-INCLUDES-MEDIASTINUM-REAL-TIME-WITH-IMAGE

CPT 766: Chest Ultrasound, Real-Time with Image Documentation

0774-FLUORESCENCE-SPECTROSCOPY-NONINVASIVE-FOR-THE-DETECTION-OF

CPT 0774: Non-Invasive Fluorescence Spectroscopy for Skin Cancer Detection

774-ELECTROCARDIOGRAM-ROUTINE-ECG-WITH-AT-LEAST-12-LEADS

CPT 774: Routine Electrocardiogram Tracing Only, No Interpretation

360-INTRODUCTION-OF-NEEDLE-OR-INTRACATHETER

CPT 360: Introduction of Needle or Intracatheter, Vein

59610-ROUTINE-OBSTETRIC-CARE-INCLUDING-ANTEPARTUM-CARE-VAGINAL

CPT 59610: Routine Obstetric Care Including Vaginal Delivery After Previous Cesarean

59510-ROUTINE-OBSTETRIC-CARE-INCLUDING-ANTEPARTUM-CARE-CESAREAN

CPT 59510: Routine Obstetric Care Including Cesarean Delivery

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Assistant-at-Surgery services are reimbursable only for procedures included on UnitedHealthcare's Assistant-at-Surgery Eligible List, which is developed from the CMS National Physician Fee Schedule (NPFS) payment indicator '2'.

Eligible list basis: CMS NPFS indicator 2.

Only one Assistant-at-Surgery is reimbursable per procedure on the Assistant-at-Surgery Eligible List.

The assistant must submit the identical procedure code(s) as the primary surgeon and report the appropriate assistant-at-surgery modifier: 80, 81, or 82 if the assistant is a Physician; AS if the assistant is a Health Care Professional.

ALL of the following

If the assistant is a Physician (modifiers 80/81/82), UnitedHealthcare reimburses 16% of the Allowable Amount for eligible procedures.
If the assistant is a Health Care Professional (modifier AS), UnitedHealthcare reimburses 14% of the Allowable Amount for eligible procedures.

Only non-global cesarean section delivery codes (without antepartum or postpartum components) are reimbursable when submitted with an Assistant Surgeon modifier; certain global cesarean CPT codes submitted by an assistant will be reimbursed as specified non-global codes (e.g., 59515 -> 59514; 59622 or 59618 -> 59620).

Multiple procedure reductions apply when an assistant submits multiple procedure codes.

Surgical technicians are not eligible to report modifier AS; their services are included in facility reimbursement and are not separately reimbursable. UnitedHealthcare will not reimburse independently submitted assistant-at-surgery services by non-contracted practitioners (other than a Physician or QHCP) unless a state mandate requires reimbursement.

Coding, Modifiers, and Payment Mapping

Accepted Assistant-at-Surgery modifiersModifierCovered

80	Assistant-at-surgery by a physician (modifier)
81	Assistant-at-surgery by a physician (modifier)
82	Assistant-at-surgery by a physician (modifier)
AS	Assistant-at-surgery by other qualified health care professional (modifier)

Cesarean reimbursement mappingCPTCovered

59514	Non-global cesarean section code used for reimbursement when assistant reports certain global cesarean codes
59620	Non-global cesarean section code used for reimbursement when assistant reports certain global cesarean codes

Multiple procedure reduction

Multiple procedure reduction ruleIf an Assistant-at-Surgery submits multiple procedure codes, multiple procedure reductions will apply.

Scope of applicationApplies when an assistant reports multiple procedure codes on the same claim.

Effect on reimbursementPayment adjustments reduce allowable amounts when more than one procedure code is submitted by the assistant.

Claims Submission and Billing Actions

Documentation Required

Claims submission and applicability

Submit accurate claims using the CMS-1500 (or electronic equivalent) when billing Assistant‑at‑Surgery services; this reimbursement policy applies to all products and to both network and non‑network physicians and other qualified health care professionals.

Use the CMS-1500 (or electronic successor) or electronic equivalent for claim submission.

Denial Risk

Surgical technicians not reimbursable with modifier AS

Do not report services performed by surgical technicians with modifier AS; per CMS guidance, surgical technician services are included in facility reimbursement and are not separately reimbursable.

Surgical technicians are not recognized as practitioners who can report modifier AS.
Services of a surgical technician assisting at surgery are included in facility reimbursement and not separately reimbursable.

Key Definitions

Allowable Amount

DefinitionThe dollar amount eligible for reimbursement to the Physician or other Qualified Health Care Professional on the claim (often referred to as an allowed amount or eligible expense).

Assistant-specific capFor Assistant-at-Surgery services, the Allowable Amount is no more than the Allowable Amount payable to the primary surgeon for the covered service with which the Assistant-at-Surgery actively assisted.

Common termsAlso referred to as allowed amount or eligible expense in benefit plan documents.

Assistant-at-Surgery / Assistant Surgeon

Role definitionA Physician or other Qualified Health Care Professional who is assisting the Physician performing a surgical procedure.

ContextServices are those where the individual actively assists the primary surgeon during a surgical procedure.

Billing implicationAssistant-at-Surgery status determines eligibility for assistant reimbursement and applicable modifiers.

Health Care Professional

DefinitionA physician assistant; clinical nurse specialist; or nurse practitioner who does not have a Doctor of Medicine (MD) or Doctor of Osteopathy (DO) degree/designation.

ClassificationConsidered a 'Health Care Professional' for assistant-at-surgery reimbursement when using the appropriate modifier (e.g., AS).

ImplicationPayment percentage and modifier requirements may differ from physicians (MD/DO).

Same Individual Physician or QHCP

DefinitionThe same individual rendering health care services reporting the same Federal Tax Identification number.

Use in claimsIndicates that services are submitted by the identical practitioner when determining reimbursement and ownership of services on the claim.

RelevanceUsed to confirm that the assistant and billed services originate from the same individual provider entity for payment considerations.