CPT Modifier 81
Published 04/05/2023
Description
Submit CPT modifier 81 to identify the services of a surgical assistant.
Guidelines and Instruction
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This modifier may only be submitted with surgery codes
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Physician assistants, nurse practitioners and clinical nurse specialists must not submit this modifier. See HCPCS modifier AS.
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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)
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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:
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A statement that no qualified resident was available to perform the service
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A statement indicating that exceptional medical circumstances exist
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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
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To determine whether the services of an assistant surgeon may be submitted to Medicare with CPT modifier 81, refer to the MPFSDB:
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Access the database directly from the CMS website
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Select Physician Fee Schedule Search from the bottom of the web page
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Screen defaults to current year. Under "Type of Information," select Payment Policy Indicators.
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Choose a single procedure code, multiple procedure codes or a range of codes, then enter the appropriate code(s)
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Select modifier (or select "All Modifiers")
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Refer to the column heading "Asst Surg"
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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.
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Indicator 1 corresponds to statutory payment restriction for assistants at surgery applies to this procedure. Assistants at surgery will not be paid.
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Indicator 2 corresponds to payment restriction for assistants at surgery does not apply to this procedure. Assistants at surgery may be paid.
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Indicator 9 corresponds to concept does not apply (the most likely explanation is that the procedure is not a surgery)