CPT Modifier 80

Description
Submit CPT modifier 80 to identify the services of a surgical assistant.

Guidelines and Instructions

• This modifier may only be submitted with surgery codes
• Supporting documentation describing the medical necessity for an assistant must be submitted with the claim for services that are Asst Surg Indicator 0 on the Medicare Physician Fee Schedule Database (MPFSDB)
• In addition, documentation to support one of the following situations 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 may be submitted to Medicare with CPT Modifier 80, refer to the MPFSDB:

• Access the database directly from the CMS website
  • Select Physician Fee Schedule Search from the bottom of the web page
  • Screen defaults to current year. Under Type of Information, select Payment Policy Indicators.
  • Choose a single procedure code, multiple procedure codes or a range of codes, then enter the appropriate code(s)
  • Select modifier (or select "all modifiers")
  • Refer to the column heading "Asst Surg"
• Indicator 0 corresponds to 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 corresponds to statutory payment restriction for assistants at surgery applies to this procedure. Assistants at surgery will not be paid.
• Indicator 2 corresponds to payment restriction for assistants at surgery does not apply to this procedure. Assistants at surgery may be paid.
• Indicator 9 corresponds to concept does not apply (the most likely explanation is that the procedure is not a surgery)