Description:
Submit CPT modifier 82 to identify services of Assistant surgeon (when qualified resident surgeon not available)
Guidelines/Instructions:
- The unavailability of a qualified resident surgeon is a prerequisite for submitting CPT modifier 82 with a surgical procedure code
- This modifier may only be submitted with surgery codes
- Physician assistants, nurse practitioners and clinical nurse specialists must not submit this modifier. See HCPCS Modifier AS.
- Supporting documentation describing the medical necessity for an assistant must be submitted with the claim for services that have Asst Surg Indicator 0 in the MPFSDB
- In addition, one of the following documentations is required in the medical record when the surgery is performed in a teaching hospital:
- A statement that no qualified resident was available to perform the service
- A statement indicating that exceptional medical circumstances exist
- A statement indicating the primary surgeon has an across the board policy of never involving residents in the preoperative, operative or postoperative care of his/her patients
To determine whether the services of an assistant surgeon may be submitted to Medicare with CPT modifier 82, refer to the Medicare Physician Fee Schedule database (MPFSDB):
- Access the database directly from the CMS Web site at www.cms.hhs.gov/PFSlookup/
- Select Physician Fee Schedule Search from the left area of the Web page
- Screen defaults to current year. Under Type of Information, select Payment Policy Indicators, then 'next'
- On the 'select field options' screen, select 'Next'
- Enter the procedure code and select 'All Modifiers', then click 'Submit'
- Refer to the column heading 'Asst Surg'
- Indicator 0 = Payment restriction for assistants at surgery applies to this procedure. Supporting documentation describing the medical necessity for an assistant must be submitted with the claim.
- Indicator 1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistants at surgery will not be paid.
- Indicator 2 = Payment restriction for assistants at surgery does not apply to this procedure. Assistants at surgery may be paid.
- Indicator 9 = Concept does not apply (the most likely explanation is that the procedure is not a surgery)
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