CPT Modifier 81
Published 07/16/2020
Description
Submit CPT modifier 81 to identify the services of a surgical assistant.
Guidelines and Instruction
- 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 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 or her patients
To determine whether the services of an assistant surgeon may be submitted to Medicare with CPT modifier 81, 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)