- Anesthesia Modifiers
- Appropriate Usage of Modifier 99
- Assistants at Surgery at Teaching Hospitals
- Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission
- Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, TI-T9 and TA vs. Modifier 50
- Correct Usage of Modifier 79 for Multiple Procedures
- Co-Surgery/Team Surgery/Assistant Surgery Modifiers
- Modifier 25
- Modifier 33
- Modifier 51
- Modifier 52 Claim Submission Billing Reminder
- Modifier 59 and the Subset Modifiers XE, XP, XS, XU - Specific Modifiers for Distinct Procedural Services
- Modifier 90 Reference to Outside Laboratory
- Modifiers Used in CMS-1500 Claim Reporting
- Modifier Usage
- Proper Billing of Surgical Comanagement (Modifiers 54 and 55)
- Proper Use of Modifiers 59 and 91
- Reminder for Submission of Modifier 22
- Repeat Procedures - Modifiers 76 and 77
Assistants at Surgery at Teaching Hospitals
CMS instructs providers to use specific modifiers on claims representing assistance during a surgical procedure:
- Modifier 80 denotes service by an assistant surgeon
- Modifier 82 denotes service by an assistant surgeon at a teaching hospital, in a situation in which no qualified surgical resident was available to assist
When a GME-approved surgical residency program exists at a teaching hospital, CMS expects that a qualified surgical resident will perform the role of surgical assistant during most, if not all, surgical procedures. Use of the 82 modifier requires documentation in the associated medical record, supporting the reason that a qualified surgical resident was unavailable to perform this service.
CMS provides an exception to this rule for attending surgeons at teaching hospitals who have established a uniform practice of excluding qualified residents from participation in preoperative, intraoperative and postoperative care for their patients.
When this exceptional circumstance occurs, the surgeon who maintains this across-the-board policy of excluding qualified residents from participation must file a statement to that effect at each teaching hospital at which he/she elects to maintain this policy. This statement must be updated by the surgeon annually and be available to submit to Medicare in the event of an audit of claims for surgical assistance occurring at that hospital.
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 20.4.3
- MLN Matters® MM61263: Payment of Assistant at Surgery Services in a Method II Critical Access Hospital (CAH) – JA6123
Revised 9/28/2023