Description
Submit CPT modifier 81 to identify the services of a surgical assistant.
Guidelines/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/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)

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department


Click to Chat Now