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Appropriate use of assistant at surgery modifiers and payment indicators
Last Modified: 7/11/2025
Location: FL, PR, USVI
Business: Part B
First Coast would like to remind providers within jurisdiction N (JN) of the appropriate use of assistant at surgery modifiers and payment under the Medicare physician fee schedule (MPFS).
An assistant at surgery is a provider who actively assists the physician in charge of a case in performing a surgical procedure. A physician, nurse practitioner, physician assistant or clinical nurse specialist who is authorized to provide such services under state law can serve as an assistant at surgery. The operative note should clearly document the assistant surgeon's role during the operative session.
Medicare considers advanced registered nurse practitioners (ARNP), physician assistants (PA), and clinical nurse specialists (CNS) as non-physician practitioners. Medicare does not recognize a registered nurse first assistant (RNFA) as a qualified Medicare provider.
To report services of an assistant surgeon, the following surgical modifiers should be appended:
• 80 -- Assistant surgeon: This modifier pertains to physician’s services only. A physician’s surgical assistant services may be identified by adding the modifier 80 to the usual procedure code. This modifier describes an assistant surgeon providing full assistance to the primary surgeon, and is not intended for use by non-physician providers.
• 81 -- Assistant surgeon: This modifier pertains to physician’s services only. Minimal surgical assistance may be identified by adding the modifier 81 to the usual procedure code, and describes an assistant surgeon providing minimal assistance to the primary surgeon. This modifier is not intended for use by non-physician providers.
Note: This modifier is used in the private insurance industry and is not commonly used in Medicare billing.
• 82 -- Assistant surgeon (when a qualified resident surgeon is not available in a teaching facility): this modifier applies to physician’s services only. The unavailability of a qualified resident surgeon is a prerequisite for use of this modifier and the service must have been performed in a teaching facility. The circumstance explaining that a resident surgeon was not available must be documented in the medical record. This modifier is not intended for use by non-physician providers.
• AS -- Non-physician provider as assistant at surgery: This modifier applies when the assistant at surgery services are provided by a PA, ARNP, or CNS.
Medicare reimburses services rendered for assistant at surgery by a physician performing as a surgical assistant at 16 percent of the MPFS amount. Services rendered for assistant at surgery by non-physician providers are reimbursed at 85 percent of 16 percent (i.e., 13.6 percent) of the MPFS amount.
When reporting services provided by non-physician practitioners acting as assistants at surgery, append modifier AS to the procedure code used to report the surgeon’s service.
If a physician appends modifier AS to procedure codes for which he/she acted as assistant at surgery, these codes will be denied (see above for modifiers that should be used by physicians).
The MPFSDB is a file layout that carriers and A/B Medicare administrative contractors use to display the total fee schedule amount, related component parts, and payment policy indicators. The assistant at surgery payment indicator describes when an assistant at surgery may be paid or not. Valid indicators are:
• 0 = Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
• 1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.
• 2 = Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.
• 9 = Concept does not apply.
If multiple services are submitted with modifiers indicating assistants at surgery, each service is independently reviewed (based on the above-listed indicators) to determine payment.
For additional information related to the MPFSDB
click here 
.
Documentation is required when modifiers 80, 81, 82 and AS modifiers are reported, and the payment indicator is a "0".
Documentation must provide a clinical picture of the patient and include:
• The procedures or services performed and support the use of modifiers 80, 81, 82 and AS
• The name of the assistant
• Evidence the assistant surgeon actively participated in the procedure
• Clearly document the assistant's role during the operative session:
• Assistant's role provides more than ancillary services
• Primary surgeon's signature:
• The assistant is not required to sign the operative report, the primary surgeon's signature is sufficient
• Modifier 82 requires the circumstance documented in the medical record that a resident surgeon was not available
Claims with modifiers 80, 81, 82 and AS should be submitted with required documentation following the Unsolicited Paperwork (PWK) process.
• The PWK is a process allowing providers to submit documentation with an initial claim:
Claims will be rejected when reporting modifiers 80, 81, 82 and AS without supporting documentation. Rejected claims will need to be resubmitted using the instructions above for submitting documentation with your initial claim.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
