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A modifier of 80, 81, 82, or AS must be used to report assistant surgery performed by an employed PA, CRNP and CNM. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practice medicine. Policy Effective Date and Defined Terms. The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net. surgery, for assistant at surgery services performed by a physician and 13.6 percent for his/her employed physician assistant (PA), certified registered nurse practitioner (CRNP) or certified nurse midwife (CNM). Note: Modifier AS must be appended to the claim line when reporting assistant surgery performed by an employed PA, CRNP and CNM. Modifier 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (when qualified resident surgeon not available) is used to bill for assistant at surgery services. When billed without modifier AS (PA, NP or CNS services for assistant at surgery) the use of these modifiers indicates that a physician served as the assistant at surgery. surgeon or assistant surgeon.

Om tjänsten:  These policies are made available to provide information on certain Humana claims payment processes.

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Humana assistant surgeon policy

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Humana assistant surgeon policy

Note: Modifier AS must be appended to the claim line when reporting assistant surgery performed by an employed PA, CRNP and CNM. CPT codes 27215-27218 for the purpose of this policy. Assistant-at-Surgery Eligible List CMS Files For Download Louisiana uses a state defined list of procedures that allow for reimbursement for assistant surgery charges. Please see the Attachment section for the state defined list Physicians (MD/DO) 2008-10-24 · an assistant at surgery shall be the lesser of the actual charge or 85 percent of the amount that would otherwise be recognized if performed by a physician who is serving as an assistant at surgery. The payment methodology for these services has been codified in regulations found at 42 CFR 414.52(d) and 414.56(c).

CCI 231.01 of the electronic Commissioned Corps Issuance System (eCCIS), formerly • Modifier 47 is used to report anesthesia by the attending or assistant surgeon. No additional benefits are allowed above the total allowed for the surgical procedure if the anesthesia services are not administered by, or under the supervision of, a doctor other than the attending surgeon or assistant surgeon. What Does Humana Require to Cover Bariatric Insurance. Unless it is stated in your policy, Humana will cover your weight loss surgery. With the help of its Bariatric Management Team, you will be guided through the weight loss surgery and for six months after the surgery. surgery or incident to another surgery. For this policy, CareSource follows the guidelines provided by OAC Rule 51602-21, “Policies for Outpatient Hospital - Services,” and applies the same exceptions identified in Appendix C of that Rule.
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It’s important for all contracted healthcare providers and administrators to review the new provider manual, as your participation agreement with the Humana Guidelines adopted by Humana. Clinical practice guidelines are resources* for Humana-contracted physicians and other Humana-contracted healthcare professionals. Humana has adopted the following guidelines: 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Humana publishes its medical claims payment policies online.

a. CCI 231.01 of the electronic Commissioned Corps Issuance System (eCCIS), formerly • Modifier 47 is used to report anesthesia by the attending or assistant surgeon. No additional benefits are allowed above the total allowed for the surgical procedure if the anesthesia services are not administered by, or under the supervision of, a doctor other than the attending surgeon or assistant surgeon. What Does Humana Require to Cover Bariatric Insurance. Unless it is stated in your policy, Humana will cover your weight loss surgery. With the help of its Bariatric Management Team, you will be guided through the weight loss surgery and for six months after the surgery.
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NY Policy: 0009 Effective: 01/01/2017 . Coverage is subject to the terms, conditions, and limitations of an individual member’s programs or products and policy criteria listed below. This reimbursement policy also applies to Employer Group surgery or incident to another surgery. For this policy, CareSource follows the guidelines provided by OAC Rule 51602-21, “Policies for Outpatient Hospital - Services,” and applies the same exceptions identified in Appendix C of that Rule. Assistant Surgeon Policy Page 2 of 2 Definitions Assistant Surgeon – A practitioner who actively assists the primary surgeon in the performance of a surgical procedure. Code Lists Assistant Surgeon Code List Resources Centers for Medicare and Medicaid Services (CMS) BCBSKS Policy Memo No. 10: Assistant Surgery January 2016 Contains Public Information.


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Humana publishes its medical claims payment policies online. The information about reimbursement methodologies and acceptable billing practices may help physicians and other healthcare providers and their billing offices bill claims more accurately.

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