03/09/2020

Billing for an Assistant Surgeon-Healthfirst

how do I bill for assistant surgent for Health First ?

Billing for an assistant surgeon for Health First is the same as any other surgical claim. The HCFAs will be identical for the primary and assistant surgeon- all surgery charges for the assistant will have with modifier -80  or 82 appended primary to any other modifier for each line item (See what is applicable in your case) Each line item will be reimbursed at a reduced rate by the managed care plan for the assistants component of the surgery.

Modifier 80

Assistant Surgeon

• Provides full assistance to the primary surgeon
• Capable of taking over the surgery should the primary surgeon become incapacitated.
• Reimbursement will be 20% of the provider’s applicable Fee Schedule allowed amount for the primary surgery

Modifier 82

Assistant Surgeon (When Qualified Resident Surgeon is not Available):

• Used primarily in teaching hospitals to indicate that a qualified resident surgeon is unavailable
• Reimbursement will be 20% of the provider’s applicable Fee Schedule allowed amount for the primary surgery