Billing for Surgical Assistants- What you should know
                     
Billing for Surgical Assistants: What you should know?
Surgical Assistants
Practices lose insurance reimbursement by incorrectly billing surgical assistants. In such cases, the major 
reason for claim denials is to use the wrong modifier/ not use the modifier. In this blog, we tried to cover every 
aspect of billing for surgical assistants including defining surgical assistants, billing guidelines, reimbursement 
policies, and accurate use of modifiers. Surgical assistance services can be provided by a Health Care 
Professional other than a Physician (i.e., Physician Assistants (PA), Nurse Practitioners (NP), or Clinical Nurse 
Specialists (CNS) in accordance with the requirements outlined in Medicare Claims Processing Manual Chapter 
12. Surgical assistants include co-surgeons, assistant-at-surgery, and team surgeons.
• Co-Surgeons are defined as two or more surgeons, where the skills of both surgeons are necessary to 
perform distinct parts of a specific operative procedure. Co-surgery is always performed during the same 
operative session.
• An assistant surgeon is defined as a physician who actively assists the operating surgeon.
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Billing for Surgical Assistants: What you should know?
• An assistant may be necessary because of the complex nature of the procedure(s) or the patient’s condition. 
The assistant surgeon is usually trained in the same specialty.
• An assistant-at-surgery may be a physician assistant, nurse practitioner, or nurse midwife acting under the 
direct supervision of a physician, where the physician acts as the surgeon and the assistant-at-surgery as an 
assistant.
• Under some circumstances, highly complex procedures may require the services of a surgical team, 
consisting of several physicians, often of different specialties, plus other highly skilled, specially trained 
personnel, and complex equipment. A physician operating in this setting is referred to as a team surgeon.
Billing for Surgical Assistants
An assistant surgeon must be appropriately board-certified or otherwise highly qualified as a skilled surgeon, 
and licensed as a physician in the state where the services are provided. 
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Billing for Surgical Assistants: What you should know?
Services by the primary surgeon will be allowed at 100 percent of the maximum allowance for the primary 
procedure performed. An additional 16 percent will be allowed to the assistant surgeon if the criteria for 
assistant surgeon services are met. An assistant surgeon may be of the same specialty or subspecialty or may be 
of a different specialty.
Modifier 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (when the qualified resident surgeon is 
not available) is used by physicians to bill for assistant surgery services. When billed with modifier AS (PA, NP, or 
CNS services for assistance at surgery) the modifiers indicate that a non-physician provider served as the 
assistant at surgery. Modifiers 80, 81, and 82 should be used for a physician to report an assistant for surgery 
services. These modifiers are not intended to be used for non-physician reporting assistants for surgery 
services.
With accurate and complete medical documentation, an experienced 
General Surgery medical billing service provider can help providers submit accurate and 
timely claims for the procedures performed.
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Billing for Surgical Assistants: What you should know?
Reimbursement for Surgical Assistants
For explaining the reimbursement for Surgical Assistants, we referred to CMS and American College of Surgeons 
guidelines as its primary source. Reimbursement for co-surgeons is 120 percent of the maximum allowance for 
the primary procedure divided equally between the co-surgeons. Reimbursement for assistant surgeons is 16 
percent of the maximum allowance for the procedure. Reimbursement for team surgery will be determined on 
an individual consideration basis. Reimbursement for Physician Assistant/Nurse Practitioner/Nurse Midwife may 
be allowed when medical necessity and appropriateness of assistant surgeon services are met, and when the 
physician assistant/nurse practitioner/nurse midwife is under the direct supervision of a physician. Separate 
reimbursement will not be allowed for the hospital-employed physician assistant/nurse practitioner/nurse 
midwife. The physician assistant/nurse practitioner/nurse midwife reimbursement for a covered procedure is 
13.6 percent of the maximum allowed for the procedure.
Billing Guidelines for Co-Surgeons
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Billing for Surgical Assistants: What you should know?
Services by surgeons of different specialties or subspecialties each performing distinct components of a 
procedure as primary surgeons will be allowed at 120 percent of the maximum allowance for the primary 
procedure. Multiple procedure guidelines may apply if additional procedures are performed. Each surgeon 
should document their distinct operative work in a separate operative report. Claims from both co-surgeons 
should report the same procedure code with modifier 62 appended. The total allowance for the operative 
session will be divided equally between the co-surgeons. Co-surgeon claims for procedures designated as co-
surgeon allowed will be denied when both surgeons have the same specialty or subspecialty. When a claim for a 
non-surgical procedure is submitted with modifier 62 for a co-surgeon, the claim will be denied because the co-
surgeon concept does not apply.
Physician Assistant/Nurse Practitioner/Nurse Midwife
A physician assistant/nurse practitioner/nurse midwife must be appropriately certified or licensed in the state 
where the services are provided, and be credentialed in the facility where the procedure is performed. 
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Billing for Surgical Assistants: What you should know?
Reimbursement may be allowed when medical necessity and appropriateness of assistant surgeon services are 
met, and when the physician assistant/nurse practitioner/nurse midwife is under the direct supervision of a 
physician. Separate reimbursement will not be allowed for the hospital-employed physician assistant/nurse 
practitioner/nurse midwife. The physician assistant/nurse practitioner/nurse midwife reimbursement for a 
covered procedure is 13.6 percent of the maximum allowed for the procedure.
Billing Guidelines for Team Surgeons
Highly complex procedures requiring multiple physicians of different specialties, and other highly skilled 
personnel and equipment may be considered for reimbursement as team surgery. Reimbursement for assistant 
surgeons is limited to 16 percent of the maximum allowance for the procedure. Services will not be reimbursed 
if the above criteria are not met. Procedures that are minor, non-surgical, or that are not of sufficient 
complexity to require multiple physicians of different specialties and other highly skilled personnel and 
equipment, do not satisfy the definition of team surgery and will be denied if submitted with modifier 66 (Team 
Surgery).
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Billing for Surgical Assistants: What you should know?
Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing and 
coding services. We referred multiple resources from CMS, Blue Cross Blue Shield of North Carolina, Moda 
Health, and UnitedHealthcare to discuss billing for surgical assistants in detail. Still, we recommend reviewing 
payer billing guidelines and reimbursement policies for accurate billing for surgical assistants. For any assistance 
needed in billing and coding for surgical services, email us at: [email protected] or call us: at 
888-357-3226.
References:
• UnitedHealthcare Assistant-at-Surgery Services Policy
• BlueCross BlueShield of North Carolina Billing Guidelines
• Moda Health: Assistant At Surgery
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