An Assistant-at-Surgery actively assists the Physician performing a surgical procedure. The Assistant-at-Surgery services which are reimbursable services are set forth on UnitedHealthcare's Assistant-at-Surgery Eligible List.
Reimbursement for Assistant-at-Surgery services, when reported by the Same Individual Physician or Other Qualified Health Care Professional, is based on whether the Assistant-at-Surgery is a Physician (designated by modifiers 80, 81 or 82) or another Qualified Health Care Professional (designated by modifier AS) acting as the surgical assistant. The services of only one Assistant-at-Surgery are reimbursable for each procedure on the Assistant-at-Surgery Eligible List. No exceptions to this policy are made for teaching hospitals or hospital bylaws.
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Q: What if hospital bylaws require the attendance of an assistant for all procedures?
A: No exceptions will be made for teaching hospitals or hospital bylaws. Hospitals must follow their own bylaws. UnitedHealthcare is not required to comply with hospital bylaws.
Q: Were all CPT codes reviewed for Assistant-at-Surgery eligibility?
A: All CPT and HCPCS codes were reviewed for Assistant-at-Surgery eligibility. It is important to note that an anesthesiologist utilizes CPT anesthesia codes and is not considered an Assistant-at-Surgery during the surgical procedure. Further, HCPCS "C" codes are for Outpatient Prospective Payment System and Assistant-at-Surgery services are not a part of this payment system.
Q: Why does UnitedHealthcare reimburse the Assistant-at-Surgery for the non-global cesarean OB codes only?
A: The global Cesarean OB codes include services for antepartum and postpartum as well as the delivery. The Assistant-at-Surgery's services are for the delivery only and are reimbursed using the non-global Cesarean OB code.
Q: Can the reimbursement to providers for Assistant-at-Surgery services provided to UnitedHealthcare enrollees vary?
A: Yes, the reimbursement for Assistant-at-Surgery services can vary. The Assistant-at-Surgery reimbursement policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare enrollees. Other factors affecting reimbursement, including but not limited to legislative mandates, the Physician or other provider contracts, and/or the enrollee’s benefit coverage documents, including provisions addressing benefits for services rendered by non-participating providers, may supplement, modify or, in some cases, supersede this policy.
Q: The CMS NPFS contains additional Assistant-at-Surgery payment policy indicators of 0, 1 and 9. Are procedure codes with any of these indicators for Assistants-at-Surgery considered for reimbursement when reported with an assistant surgeon modifier?
A: No, only procedure codes included on the Assistant-at-Surgery Eligible List will be considered for reimbursement. This list is based on the CMS NPFS payment policy indicator “2” for “Assistants-at-Surgery”.