CurrentUnitedHealthcarePolicy N/A

Assistant-at-Surgery reimbursement

Defines UnitedHealthcare's reimbursement rules for Assistant-at-Surgery services billed on CMS-1500/UB04 forms, including which procedures are eligible and reimbursement percentages for physicians and other qualified health care professionals.

Policy Summary

PayerUnitedHealthcare

PolicyAssistant-at-Surgery reimbursement

Policy CodePolicy N/A

Change TypeOperational additions to eligible codes and attachment added

Effective DateN/A

Next Review DateN/A

Key ActionSubmit accurate claims using CMS-1500 or electronic equivalent and report assistant services with the appropriate assistant surgeon modifier and same procedure code(s) as the primary surgeon.

SourceLink

POLICY UPDATE CHANGES

Q&A #6 added allowing codes not on the CMS NPFS to be added to the policy if determined reimbursable.

Assistant-at-Surgery Eligible List added as an attachment.

16%physician assistant reimbursement

14%health care professional reimbursement

1assistants reimbursable per procedure

CMS NPFS '2'primary inclusion basis

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.

cesarean coding approach

Assistant-at-Surgery Coverage Criteria

Coding and Reimbursement Details

Assistant-at-Surgery Eligible CPT CodesCPTCovered

59510	Cesarean delivery only - replaced by 59514 per policy guidance
59515	Cesarean delivery including postpartum care - consolidated to 59514/59515 guidance
59618	Cesarean delivery after attempted vaginal delivery - replaced by 59620 per policy guidance
59622	Cesarean delivery including postpartum care after attempted vaginal delivery - consolidated to 59620/59622 guidance
59514	Cesarean delivery only (current code to use when appropriate)
59620	Cesarean delivery after attempted vaginal delivery (current code to use when appropriate)

Physician Assistant-at-Surgery Reimbursement16% of the Allowable Amount for eligible surgical procedures when provided by a Physician. Submit identical procedure code(s) as the primary surgeon with modifier 80, 81, or 82.

Health Care Professional Assistant-at-Surgery Reimbursement14% of the Allowable Amount for eligible surgical procedures when provided by an eligible Health Care Professional. Submit identical procedure code(s) as the primary surgeon with modifier AS. Surgical technicians may not report modifier AS; their services are included in facility reimbursement.

Cesarean Code Mapping RequirementCodes 59510/59515/59618/59622 should be reported using current applicable codes 59514 or 59620 as appropriate. Preserve use of Assistant-at-Surgery modifiers per provider type when billing these cesarean delivery services.

Claims Submission and Provider Billing Actions

Billing Rule

Claims submission and assistant surgeon modifiers

Submit accurate claims on the CMS-1500 (or electronic equivalent) and report assistant-at-surgery services using the appropriate assistant surgeon modifier and the same procedure code(s) as the primary surgeon.

Use assistant surgeon modifiers (80, 81, 82, AS) as appropriate when reporting an assistant-at-surgery.
Report the identical procedure code(s) as the primary surgeon on the CMS-1500 or electronic equivalent.

Billing Rule

Multiple procedure reductions for assistants

When an Assistant-at-Surgery submits multiple procedure codes on a claim, multiple procedure reductions will be applied.

Ensure claim lines reflect correct primary and secondary procedures so reductions are applied appropriately.

Key Definitions

Allowable Amount

DefinitionAllowable Amount = the 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 health care services with which the Assistant-at-Surgery actively assisted.

Use in calculationsReimbursement percentages (16% for physicians, 14% for health care professionals) are applied to the Allowable Amount to determine assistant payment.

Assistant-at-Surgery

DefinitionAssistant-at-Surgery / Assistant Surgeon = a Physician or other Qualified Health Care Professional who is assisting the Physician performing a surgical procedure.

Claim reporting

Policy Summary

PayerUnitedHealthcare

PolicyAssistant-at-Surgery reimbursement

Policy CodePolicy N/A

Change TypeOperational additions to eligible codes and attachment added

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

Assistant-at-Surgery services must be reported with the appropriate Assistant Surgeon modifier (80, 81, 82 for physicians; AS for qualified health care professionals) and the identical procedure code(s) as the primary surgeon.

Eligible proceduresAssistant-at-Surgery services are reimbursable only for procedures on UnitedHealthcare's Assistant-at-Surgery Eligible List, which is based on CMS NPFS indicator '2' (and may include additional codes deemed reimbursable).

Health Care Professional

DefinitionHealth Care Professional = a physician assistant, clinical nurse specialist, or nurse practitioner who does not have an MD or DO degree.

Billing modifierHealth Care Professionals acting as assistants should report the identical procedure code(s) as the primary surgeon with modifier AS.

Reimbursement ruleUnitedHealthcare reimburses Health Care Professional assistants at 14% of the Allowable Amount for eligible procedures.

ExclusionsSurgical technicians are not considered Health Care Professionals for modifier AS reporting; their services are included in facility reimbursement and are not separately reimbursable.

Physician

DefinitionPhysician = a Doctor of Medicine (MD) or Doctor of Osteopathy (DO).

Assistant billingPhysicians acting as Assistant-at-Surgery should submit the identical procedure code(s) as the primary surgeon with modifier 80, 81, or 82 to represent their service(s).

Reimbursement ruleUnitedHealthcare reimburses Physician assistants-at-surgery at 16% of the Allowable Amount for eligible procedures (percentage based on CMS).