An assistant at surgery is defined as a physician, nurse practitioner, clinical nurse specialist, or physician assistant who is licensed and actively assists the physician in charge of a case in performing a surgical procedure.
Procedures billed with the assistant at surgery physician modifiers 80, 81, 82 OR the AS modifier for physician assistants (PA), nurse practitioners (CRNP) and clinical nurse specialists (CNS), are subject to the Medicare Physician Fee Schedule Database (MPFSDB)*.
Payment may be made for the surgical procedures with these modifiers only if the services of an assistant surgeon are applicable.
The AS modifier must be reported on the claim form when billing physician assistant, nurse practitioners or clinical nurse specialists.
A Doctor of Medicine (MD)/Doctor of Osteopathic Medicine (DO) should not submit the "AS" modifier. This modifier is only valid for use by non-physician practitioners (NPP) when billing under their own provider number.
Surgical assistance is not covered when performed by a doctor who performs and bills for another surgical procedure during the same operative session.
Payment will be made to a physician for assistant surgery performed by his/her employed physician assistant (PA), or certified registered nurse practitioner (CRNP) or certified nurse midwife (CNM).
*Assistant Surgery Payment Indicator
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. Assistants at surgery may not be paid. |
2 |
Payment restriction for assistants at surgery does not apply to this procedure. Assistants at surgery may be paid. |
9 |
Assistant at surgery concept does not apply. |
Per Medicare Physician Fee Schedule (MPFS)
Procedure Codes Eligible for Assistant Surgery Payment*
*Procedure codes listed on this attachment are updated on a quarterly basis. Therefore, for the most accurate and up- to- date information refer to the Physician Fee Schedule Search referenced in the Medical policy.
Integumentary System
12018 |
12047 |
12057 |
14301 |
14302 |
15734 |
15738 |
15750 |
15756 |
15757 |
15758 |
15770 |
15830 |
15832 |
15841 |
15842 |
15845 |
15847 |
15922 |
15935 |
15952 |
19302 |
19303 |
19305 |
19306 |
19307 |
19316 |
19318 |
19357 |
19361 |
19364 |
19367 |
19368 |
19369 |
|
Musculoskeletal System
20100 |
20150 |
20251 |
20692 |
20696 |
20697 |
20802 |
20805 |
20808 |
20816 |
20822 |
20824 |
20827 |
20838 |
20900 |
20902 |
20922 |
20924 |
20932 |
20933 |
20934 |
20937 |
20938 |
20955 |
20956 |
20957 |
20962 |
20969 |
20970 |
20972 |
20973 |
20975 |
21011 |
21012 |
21013 |
21014 |
21016 |
21034 |
21044 |
21045 |
21047 |
21049 |
21060 |
21121 |
21122 |
21123 |
21125 |
21127 |
21137 |
21138 |
21139 |
21141 |
21142 |
21143 |
21145 |
21146 |
21147 |
21150 |
21151 |
21154 |
21155 |
21159 |
21160 |
21172 |
21175 |
21179 |
21180 |
21182 |
21183 |
21184 |
21188 |
21193 |
21194 |
21195 |
21196 |
21198 |
21199 |
21206 |
21209 |
21240 |
21242 |
21243 |
21244 |
21245 |
21246 |
21247 |
21255 |
21256 |
21260 |
21261 |
21263 |
21267 |
21268 |
21270 |
21275 |
21339 |
21343 |
21344 |
21347 |
21348 |
21360 |
21365 |
21366 |
21385 |
21386 |
21387 |
21390 |
21395 |
21401 |
21406 |
21407 |
21408 |
21422 |
21423 |
21431 |
21432 |
21433 |
21435 |
21436 |
21445 |
21462 |
21465 |
21470 |
21490 |
21502 |
21552 |
21554 |
21557 |
21558 |
21600 |
21601 |
21602 |
21603 |
21610 |
21615 |
21616 |
21620 |
21627 |
21630 |
21632 |
21685 |
21700 |
21705 |
21720 |
21725 |
21740 |
21742 |
21743 |
21750 |
21811 |
21812 |
21813 |
21825 |
21931 |
21932 |
21933 |
21936 |
22100 |
22101 |
22102 |
22103 |
22110 |
22112 |
22114 |
22116 |
22206 |
22207 |
22208 |
22210 |
22212 |
22214 |
22216 |
22220 |
22222 |
22224 |
22226 |
22318 |
22319 |
22325 |
22326 |
22327 |
22328 |
22532 |
22533 |
22534 |
22548 |
22551 |
22552 |
22554 |
22556 |
22558 |
22585 |
22586 |
22590 |
22595 |
22600 |
22610 |
22612 |
22614 |
22630 |
22632 |
22633 |
22634 |
22800 |
22802 |
22804 |
22808 |
22810 |
22812 |
22818 |
22819 |
22830 |
22840 |
22842 |
22843 |
22844 |
22845 |
22846 |
22847 |
22848 |
22849 |
22850 |
22852 |
22853 |
22854 |
22855 |
22856 |
22857 |
22858 |
22859 |
22861 |
22862 |
22864 |
22865 |
22867 |
22868 |
22869 |
22870 |
22899 |
22900 |
22901 |
22902 |
22903 |
22904 |
22905 |
23000 |
23020 |
23035 |
23040 |
23071 |
23073 |
23077 |
23078 |
23100 |
23105 |
23107 |
23120 |
23125 |
23145 |
23150 |
23155 |
23156 |
23172 |
23174 |
23182 |
23184 |
23190 |
23195 |
23200 |
23210 |
23220 |
23395 |
23397 |
23400 |
23405 |
23406 |
23410 |
23412 |
23420 |
23430 |
23440 |
23450 |
23455 |
23460 |
23462 |
23465 |
23466 |
23470 |
23472 |
23473 |
23474 |
23485 |
23490 |
23491 |
23515 |
23530 |
23532 |
23550 |
23552 |
23585 |
23615 |
23616 |
23630 |
23660 |
23670 |
23680 |
23800 |
23802 |
23900 |
23920 |
23929 |
24006 |
24071 |
24073 |
24079 |
24100 |
24101 |
24102 |
24115 |
24116 |
24125 |
24126 |
24134 |
24138 |
24140 |
24149 |
24150 |
24152 |
24155 |
24301 |
24320 |
24330 |
24331 |
24340 |
24341 |
24342 |
24343 |
24344 |
24345 |
24346 |
24360 |
24361 |
24362 |
24363 |
24365 |
24366 |
24370 |
24371 |
24400 |
24410 |
24420 |
24430 |
24435 |
24470 |
24498 |
24515 |
24516 |
24545 |
24546 |
24575 |
24579 |
24586 |
24587 |
24615 |
24635 |
24665 |
24666 |
24685 |
24800 |
24802 |
24900 |
24920 |
24925 |
24930 |
24931 |
24940 |
25071 |
25073 |
25078 |
25085 |
25107 |
25119 |
25126 |
25135 |
25136 |
25145 |
25151 |
25170 |
25215 |
25250 |
25251 |
25263 |
25265 |
25300 |
25301 |
25310 |
25312 |
25315 |
25316 |
25320 |
25332 |
25335 |
25350 |
25355 |
25360 |
25365 |
25370 |
25375 |
25390 |
25391 |
25392 |
25393 |
25394 |
25400 |
25405 |
25415 |
25420 |
25425 |
25426 |
25431 |
25440 |
25441 |
25442 |
25443 |
25444 |
25446 |
25447 |
25449 |
25490 |
25491 |
25492 |
25515 |
25525 |
25526 |
25545 |
25574 |
25575 |
25607 |
25608 |
25609 |
25628 |
25645 |
25670 |
25676 |
25685 |
25695 |
25800 |
25805 |
25810 |
25820 |
25825 |
25830 |
25905 |
25907 |
25909 |
25915 |
25922 |
25924 |
25929 |
26111 |
26113 |
26118 |
26185 |
26260 |
26262 |
26352 |
26357 |
26358 |
26372 |
26373 |
26390 |
26392 |
26420 |
26434 |
26474 |
26479 |
26483 |
26485 |
26492 |
26494 |
26497 |
26498 |
26499 |
26502 |
26517 |
26518 |
26530 |
26531 |
26541 |
26546 |
26550 |
26551 |
26553 |
26554 |
26555 |
26556 |
26560 |
26561 |
26562 |
26565 |
26568 |
26580 |
26587 |
26590 |
26596 |
26686 |
26820 |
26842 |
26843 |
26844 |
26852 |
26862 |
26863 |
27001 |
27003 |
27005 |
27006 |
27030 |
27033 |
27035 |
27036 |
27045 |
27048 |
27049 |
27052 |
27054 |
27059 |
27065 |
27066 |
27067 |
27070 |
27071 |
27075 |
27076 |
27077 |
27078 |
27080 |
27087 |
27090 |
27091 |
27097 |
27098 |
27100 |
27105 |
27110 |
27111 |
27120 |
27122 |
27125 |
27130 |
27132 |
27134 |
27137 |
27138 |
27140 |
27146 |
27147 |
27151 |
27156 |
27158 |
27161 |
27165 |
27170 |
27176 |
27177 |
27178 |
27179 |
27181 |
27187 |
27202 |
27226 |
27227 |
27228 |
27236 |
27244 |
27245 |
27248 |
27253 |
27254 |
27258 |
27259 |
27267 |
27268 |
27269 |
27279 |
27280 |
27282 |
27284 |
27286 |
27290 |
27295 |
27299 |
27303 |
27305 |
27306 |
27310 |
27325 |
27326 |
27329 |
27331 |
27332 |
27333 |
27334 |
27335 |
27337 |
27339 |
27345 |
27347 |
27350 |
27355 |
27356 |
27357 |
27358 |
27360 |
27364 |
27365 |
27380 |
27381 |
27385 |
27386 |
27390 |
27392 |
27393 |
27394 |
27395 |
27396 |
27397 |
27400 |
27403 |
27405 |
27407 |
27409 |
27412 |
27415 |
27418 |
27420 |
27422 |
27424 |
27427 |
27428 |
27429 |
27430 |
27435 |
27438 |
27440 |
27441 |
27442 |
27443 |
27445 |
27446 |
27447 |
27448 |
27450 |
27454 |
27455 |
27457 |
27465 |
27466 |
27468 |
27470 |
27472 |
27479 |
27486 |
27487 |
27488 |
27495 |
27498 |
27499 |
27506 |
27507 |
27511 |
27513 |
27514 |
27519 |
27524 |
27535 |
27536 |
27540 |
27556 |
27557 |
27558 |
27566 |
27580 |
27590 |
27591 |
27592 |
27598 |
27599 |
27602 |
27612 |
27620 |
27625 |
27626 |
27632 |
27634 |
27637 |
27638 |
27645 |
27646 |
27647 |
27650 |
27654 |
27656 |
27658 |
27659 |
27665 |
27675 |
27676 |
27685 |
27687 |
27690 |
27691 |
27692 |
27698 |
27700 |
27702 |
27703 |
27705 |
27709 |
27712 |
27715 |
27720 |
27722 |
27724 |
27725 |
27727 |
27740 |
27742 |
27745 |
27756 |
27758 |
27759 |
27814 |
27822 |
27823 |
27826 |
27827 |
27828 |
27829 |
27832 |
27846 |
27848 |
27870 |
27871 |
27880 |
27881 |
27888 |
27894 |
28039 |
28047 |
28086 |
28100 |
28102 |
28103 |
28104 |
28106 |
28107 |
28114 |
28118 |
28122 |
28130 |
28171 |
28202 |
28210 |
28238 |
28250 |
28260 |
28262 |
28264 |
28289 |
28291 |
28292 |
28295 |
28296 |
28297 |
28298 |
28299 |
28300 |
28302 |
28304 |
28305 |
28306 |
28308 |
28320 |
28322 |
28360 |
28415 |
28420 |
28445 |
28446 |
28555 |
28585 |
28615 |
28705 |
28715 |
28725 |
28730 |
28735 |
28737 |
28740 |
28760 |
28800 |
29804 |
29820 |
29821 |
29822 |
29823 |
29824 |
29825 |
29826 |
29827 |
29828 |
29834 |
29835 |
29836 |
29837 |
29843 |
29844 |
29845 |
29847 |
29851 |
29855 |
29856 |
29860 |
29861 |
29862 |
29863 |
29884 |
29885 |
29887 |
29888 |
29889 |
29891 |
29892 |
29894 |
29895 |
29897 |
29898 |
29899 |
29904 |
29905 |
29906 |
29907 |
29914 |
29915 |
29916 |
G0412 |
G0413 |
G0414 |
G0415 |
0656T |
0657T |
|
|
Respiratory System
30125 |
30160 |
30410 |
30430 |
30435 |
30450 |
30460 |
30462 |
30540 |
30545 |
31075 |
31080 |
31081 |
31084 |
31085 |
31086 |
31087 |
31205 |
31225 |
31230 |
31295 |
31296 |
31300 |
31360 |
31365 |
31367 |
31368 |
31370 |
31375 |
31380 |
31382 |
31390 |
31395 |
31400 |
31420 |
31590 |
31601 |
31611 |
31634 |
31750 |
31755 |
31760 |
31766 |
31770 |
31775 |
31780 |
31781 |
31785 |
31786 |
31805 |
32035 |
32036 |
32096 |
32097 |
32098 |
32100 |
32110 |
32120 |
32124 |
32140 |
32141 |
32150 |
32151 |
32160 |
32200 |
32215 |
32220 |
32225 |
32310 |
32320 |
32440 |
32442 |
32445 |
32480 |
32482 |
32484 |
32486 |
32488 |
32491 |
32501 |
32503 |
32504 |
32505 |
32506 |
32507 |
32540 |
32553 |
32561 |
32562 |
32650 |
32651 |
32652 |
32653 |
32654 |
32655 |
32656 |
32658 |
32659 |
32661 |
32662 |
32663 |
32664 |
32665 |
32666 |
32667 |
32668 |
32669 |
32670 |
32671 |
32672 |
32673 |
32674 |
32800 |
32810 |
32815 |
32820 |
32851 |
32852 |
32853 |
32854 |
32855 |
32856 |
32900 |
32905 |
32906 |
32940 |
32994 |
32998 |
0494T |
|
|
|
|
Cardiovascular System
33020 |
33025 |
33030 |
33031 |
33050 |
33120 |
33130 |
33140 |
33141 |
33243 |
33250 |
33251 |
33254 |
33255 |
33256 |
33257 |
33258 |
33259 |
33261 |
33265 |
33266 |
33300 |
33305 |
33310 |
33315 |
33320 |
33321 |
33322 |
33330 |
33335 |
33390 |
33391 |
33404 |
33405 |
33406 |
33410 |
33411 |
33412 |
33413 |
33414 |
33415 |
33416 |
33417 |
33418 |
33419 |
33422 |
33425 |
33426 |
33427 |
33430 |
33440 |
33460 |
33463 |
33464 |
33465 |
33468 |
33470 |
33471 |
33474 |
33475 |
33476 |
33478 |
33496 |
33500 |
33501 |
33502 |
33504 |
33505 |
33506 |
33507 |
33508 |
33510 |
33511 |
33512 |
33513 |
33514 |
33516 |
33517 |
33518 |
33519 |
33521 |
33522 |
33523 |
33530 |
33533 |
33534 |
33535 |
33536 |
33542 |
33545 |
33548 |
33572 |
33600 |
33602 |
33606 |
33608 |
33610 |
33611 |
33612 |
33615 |
33617 |
33619 |
33620 |
33621 |
33622 |
33641 |
33645 |
33647 |
33660 |
33665 |
33670 |
33675 |
33676 |
33677 |
33681 |
33684 |
33688 |
33690 |
33692 |
33694 |
33697 |
33702 |
33710 |
33720 |
33722 |
33724 |
33726 |
33730 |
33732 |
33735 |
33736 |
33737 |
33741 |
33745 |
33746 |
33750 |
33755 |
33762 |
33764 |
33766 |
33767 |
33768 |
33770 |
33771 |
33774 |
33775 |
33776 |
33777 |
33778 |
33779 |
33780 |
33781 |
33782 |
33783 |
33786 |
33788 |
33800 |
33802 |
33803 |
33813 |
33814 |
33820 |
33822 |
33824 |
33840 |
33845 |
33851 |
33852 |
33853 |
33858 |
33859 |
33863 |
33864 |
33871 |
33875 |
33877 |
33880 |
33881 |
33883 |
33884 |
33886 |
33889 |
33891 |
33910 |
33915 |
33916 |
33917 |
33920 |
33922 |
33924 |
33925 |
33926 |
33927 |
33928 |
33929 |
33933 |
33935 |
33944 |
33945 |
33970 |
33973 |
33975 |
33976 |
33977 |
33978 |
33979 |
33980 |
33981 |
33982 |
33983 |
33990 |
33991 |
33992 |
33993 |
33995 |
33997 |
33999 |
34001 |
34051 |
34101 |
34111 |
34151 |
34201 |
34203 |
34401 |
34421 |
34451 |
34501 |
34502 |
34510 |
34520 |
34530 |
34701 |
34702 |
34703 |
34704 |
34705 |
34706 |
34707 |
34708 |
34709 |
34710 |
34711 |
34712 |
34713 |
34714 |
34715 |
34716 |
34717 |
34718 |
34808 |
34812 |
34813 |
34820 |
34830 |
34831 |
34832 |
34833 |
34834 |
34841 |
34842 |
34843 |
34844 |
34845 |
34846 |
34847 |
34848 |
35001 |
35002 |
35005 |
35011 |
35013 |
35021 |
35022 |
35045 |
35081 |
35082 |
35091 |
35092 |
35102 |
35103 |
35111 |
35112 |
35121 |
35122 |
35131 |
35132 |
35141 |
35142 |
35151 |
35152 |
35180 |
35182 |
35184 |
35188 |
35189 |
35190 |
35201 |
35206 |
35211 |
35216 |
35221 |
35226 |
35231 |
35236 |
35241 |
35246 |
35251 |
35256 |
35261 |
35266 |
35271 |
35276 |
35281 |
35286 |
35301 |
35302 |
35303 |
35304 |
35305 |
35306 |
35311 |
35321 |
35331 |
35341 |
35351 |
35355 |
35361 |
35363 |
35371 |
35372 |
35390 |
35500 |
35501 |
35506 |
35508 |
35509 |
35510 |
35511 |
35512 |
35515 |
35516 |
35518 |
35521 |
35522 |
35523 |
35525 |
35526 |
35531 |
35533 |
35535 |
35536 |
35537 |
35538 |
35539 |
35556 |
35558 |
35560 |
35563 |
35565 |
35566 |
35570 |
35571 |
35572 |
35583 |
35585 |
35587 |
35600 |
35601 |
35606 |
35612 |
35616 |
35621 |
35623 |
35626 |
35631 |
35632 |
35633 |
35634 |
35636 |
35637 |
35638 |
35642 |
35645 |
35646 |
35647 |
35650 |
35654 |
35656 |
35661 |
35663 |
35665 |
35666 |
35671 |
35681 |
35685 |
35686 |
35691 |
35693 |
35694 |
35695 |
35697 |
35700 |
35701 |
35702 |
35703 |
35800 |
35820 |
35840 |
35860 |
35870 |
35876 |
35879 |
35881 |
35883 |
35884 |
35901 |
35903 |
35905 |
35907 |
36261 |
36460 |
36818 |
36819 |
36820 |
36821 |
36825 |
36830 |
36831 |
36832 |
36833 |
36838 |
37145 |
37160 |
37180 |
37181 |
37600 |
37605 |
37606 |
37615 |
37616 |
37617 |
37618 |
37619 |
37660 |
37761 |
37788 |
93590 |
93592 |
G2170 |
G2171 |
|
|
|
|
Hemic-Lymphatic System
38100 |
38101 |
38102 |
38115 |
38120 |
38129 |
38308 |
38380 |
38381 |
38382 |
38530 |
38542 |
38555 |
38562 |
38564 |
38570 |
38571 |
38572 |
38573 |
38589 |
|
Mediastinum and Diaphragm
38700 |
38720 |
38724 |
38740 |
38745 |
38746 |
38747 |
38760 |
38765 |
38770 |
38780 |
38900 |
39000 |
39010 |
39200 |
39220 |
39499 |
39501 |
39503 |
39540 |
39541 |
39545 |
39560 |
39561 |
39599 |
|
|
|
Digestive System
40701 |
40702 |
40799 |
40840 |
40843 |
40844 |
41120 |
41130 |
41135 |
41140 |
41145 |
41150 |
41153 |
41155 |
42120 |
42200 |
42205 |
42210 |
42215 |
42220 |
42225 |
42226 |
42227 |
42235 |
42260 |
42299 |
42409 |
42410 |
42415 |
42420 |
42425 |
42426 |
42440 |
42507 |
42510 |
42699 |
42725 |
42810 |
42815 |
42844 |
42845 |
42890 |
42892 |
42894 |
42950 |
42953 |
42955 |
42961 |
42971 |
42972 |
43020 |
43030 |
43045 |
43100 |
43101 |
43107 |
43108 |
43112 |
43113 |
43116 |
43117 |
43118 |
43121 |
43122 |
43123 |
43124 |
43130 |
43135 |
43279 |
43280 |
43281 |
43282 |
43283 |
43284 |
43285 |
43286 |
43287 |
43288 |
43289 |
43300 |
43305 |
43310 |
43312 |
43313 |
43314 |
43320 |
43325 |
43327 |
43328 |
43330 |
43331 |
43332 |
43333 |
43334 |
43335 |
43336 |
43337 |
43338 |
43340 |
43341 |
43351 |
43352 |
43360 |
43361 |
43400 |
43405 |
43410 |
43415 |
43425 |
43496 |
43500 |
43501 |
43502 |
43510 |
43520 |
43605 |
43610 |
43611 |
43620 |
43621 |
43622 |
43631 |
43632 |
43633 |
43634 |
43635 |
43640 |
43641 |
43644 |
43645 |
43647 |
43648 |
43651 |
43652 |
43653 |
43659 |
43753 |
43754 |
43755 |
43756 |
43757 |
43770 |
43771 |
43772 |
43773 |
43774 |
43775 |
43800 |
43810 |
43820 |
43825 |
43830 |
43831 |
43832 |
43840 |
43843 |
43845 |
43846 |
43847 |
43848 |
43850 |
43855 |
43860 |
43865 |
43870 |
43880 |
43881 |
43882 |
43886 |
43887 |
43888 |
44005 |
44010 |
44015 |
44020 |
44021 |
44025 |
44050 |
44055 |
44110 |
44111 |
44120 |
44121 |
44125 |
44126 |
44127 |
44128 |
44130 |
44137 |
44139 |
44140 |
44141 |
44143 |
44144 |
44145 |
44146 |
44147 |
44150 |
44151 |
44155 |
44156 |
44157 |
44158 |
44160 |
44180 |
44186 |
44187 |
44188 |
44202 |
44203 |
44204 |
44205 |
44206 |
44207 |
44208 |
44210 |
44211 |
44212 |
44213 |
44227 |
44238 |
44300 |
44310 |
44314 |
44316 |
44320 |
44322 |
44345 |
44346 |
44602 |
44603 |
44604 |
44605 |
44615 |
44620 |
44625 |
44626 |
44640 |
44650 |
44660 |
44661 |
44680 |
44700 |
44701 |
44715 |
44720 |
44721 |
44800 |
44820 |
44850 |
44899 |
44900 |
44950 |
44955 |
44960 |
44970 |
44979 |
45110 |
45111 |
45112 |
45113 |
45114 |
45116 |
45119 |
45120 |
45121 |
45123 |
45126 |
45130 |
45135 |
45136 |
45160 |
45171 |
45172 |
45395 |
45397 |
45400 |
45402 |
45499 |
45540 |
45541 |
45550 |
45560 |
45562 |
45563 |
45800 |
45805 |
45820 |
45825 |
46705 |
46710 |
46712 |
46715 |
46716 |
46730 |
46735 |
46740 |
46742 |
46744 |
46746 |
46748 |
46750 |
46751 |
46760 |
46761 |
47010 |
47015 |
47100 |
47120 |
47122 |
47125 |
47130 |
47135 |
47140 |
47141 |
47142 |
47143 |
47144 |
47145 |
47146 |
47147 |
47300 |
47350 |
47360 |
47361 |
47362 |
47370 |
47371 |
47379 |
47380 |
47381 |
47400 |
47420 |
47425 |
47460 |
47480 |
47550 |
47562 |
47563 |
47564 |
47570 |
47579 |
47600 |
47605 |
47610 |
47612 |
47620 |
47700 |
47711 |
47712 |
47715 |
47720 |
47721 |
47740 |
47741 |
47760 |
47765 |
47780 |
47785 |
47800 |
47801 |
47802 |
47900 |
48000 |
48001 |
48020 |
48100 |
48105 |
48120 |
48140 |
48145 |
48146 |
48148 |
48150 |
48152 |
48153 |
48154 |
48155 |
48500 |
48510 |
48520 |
48540 |
48545 |
48547 |
48548 |
48551 |
48552 |
48554 |
48556 |
48999 |
49000 |
49002 |
49010 |
49020 |
49040 |
49062 |
49203 |
49204 |
49205 |
49215 |
49255 |
49320 |
49321 |
49322 |
49323 |
49324 |
49325 |
49326 |
49327 |
49329 |
49425 |
49435 |
49436 |
49491 |
49492 |
49495 |
49496 |
49500 |
49501 |
49505 |
49507 |
49520 |
49521 |
49525 |
49540 |
49550 |
49553 |
49555 |
49557 |
49560 |
49561 |
49565 |
49566 |
49568 |
49570 |
49572 |
49580 |
49582 |
49585 |
49587 |
49590 |
49600 |
49605 |
49606 |
49610 |
49611 |
49650 |
49651 |
49652 |
49653 |
49654 |
49655 |
49656 |
49657 |
49659 |
49900 |
49905 |
G0276 |
|
|
|
|
Urinary System
50010 |
50045 |
50060 |
50065 |
50070 |
50075 |
50081 |
50100 |
50120 |
50125 |
50130 |
50135 |
50205 |
50220 |
50225 |
50230 |
50234 |
50236 |
50240 |
50250 |
50280 |
50290 |
50320 |
50323 |
50325 |
50327 |
50328 |
50329 |
50340 |
50360 |
50365 |
50370 |
50380 |
50400 |
50405 |
50500 |
50520 |
50525 |
50526 |
50540 |
50541 |
50542 |
50543 |
50544 |
50545 |
50546 |
50547 |
50548 |
50549 |
50562 |
50593 |
50600 |
50605 |
50610 |
50620 |
50630 |
50650 |
50660 |
50700 |
50715 |
50722 |
50725 |
50727 |
50728 |
50740 |
50750 |
50760 |
50770 |
50780 |
50782 |
50783 |
50785 |
50800 |
50810 |
50815 |
50820 |
50825 |
50830 |
50840 |
50845 |
50860 |
50900 |
50920 |
50930 |
50940 |
50945 |
50947 |
50948 |
50949 |
51020 |
51040 |
51045 |
51050 |
51060 |
51080 |
51500 |
51520 |
51525 |
51530 |
51535 |
51550 |
51555 |
51565 |
51570 |
51575 |
51580 |
51585 |
51590 |
51595 |
51596 |
51597 |
51800 |
51820 |
51840 |
51841 |
51845 |
51860 |
51865 |
51880 |
51900 |
51920 |
51925 |
51940 |
51960 |
51980 |
51990 |
51992 |
53085 |
53210 |
53215 |
53230 |
53235 |
53400 |
53405 |
53410 |
53415 |
53425 |
53430 |
53431 |
53440 |
53442 |
53444 |
53445 |
53446 |
53447 |
53448 |
53449 |
53500 |
53505 |
53510 |
53515 |
|
|
|
Male Genital System
54110 |
54111 |
54112 |
54115 |
54120 |
54125 |
54130 |
54135 |
54205 |
54300 |
54304 |
54308 |
54312 |
54316 |
54318 |
54322 |
54324 |
54326 |
54328 |
54332 |
54336 |
54340 |
54344 |
54348 |
54352 |
54360 |
54380 |
54385 |
54390 |
54405 |
54406 |
54408 |
54410 |
54411 |
54415 |
54416 |
54417 |
54420 |
54430 |
54437 |
54438 |
54440 |
54522 |
54530 |
54535 |
54550 |
54560 |
54650 |
54680 |
54690 |
54699 |
55150 |
55400 |
55520 |
55535 |
55550 |
55559 |
55650 |
55706 |
55720 |
55725 |
55801 |
55810 |
55812 |
55815 |
55821 |
55831 |
55840 |
55842 |
55845 |
55862 |
55865 |
55866 |
|
|
|
|
Female Genital System
56620 |
56625 |
56630 |
56631 |
56632 |
56633 |
56634 |
56637 |
56640 |
56700 |
56800 |
56805 |
56810 |
57106 |
57107 |
57109 |
57110 |
57111 |
57120 |
57130 |
57200 |
57210 |
57220 |
57230 |
57240 |
57250 |
57260 |
57265 |
57267 |
57268 |
57270 |
57280 |
57282 |
57283 |
57284 |
57285 |
57287 |
57288 |
57289 |
57291 |
57292 |
57295 |
57296 |
57300 |
57305 |
57307 |
57308 |
57310 |
57311 |
57320 |
57330 |
57335 |
57423 |
57425 |
57426 |
57530 |
57531 |
57540 |
57545 |
57550 |
57555 |
57556 |
57720 |
58140 |
58145 |
58146 |
58150 |
58152 |
58180 |
58200 |
58210 |
58240 |
58260 |
58262 |
58263 |
58267 |
58270 |
58275 |
58280 |
58285 |
58290 |
58291 |
58292 |
58294 |
58345 |
58356 |
58400 |
58410 |
58520 |
58540 |
58541 |
58542 |
58543 |
58544 |
58545 |
58546 |
58548 |
58550 |
58552 |
58553 |
58554 |
58560 |
58570 |
58571 |
58572 |
58573 |
58575 |
58578 |
58579 |
58600 |
58605 |
58611 |
58615 |
58660 |
58661 |
58662 |
58672 |
58673 |
58674 |
58679 |
58700 |
58720 |
58740 |
58750 |
58752 |
58760 |
58770 |
58805 |
58820 |
58822 |
58825 |
58900 |
58920 |
58925 |
58940 |
58943 |
58950 |
58951 |
58952 |
58953 |
58954 |
58956 |
58957 |
58958 |
58960 |
58974 |
58976 |
0668T |
0669T |
0670T |
|
|
|
|
Maternity Care
59070 |
59074 |
59076 |
59100 |
59120 |
59121 |
59136 |
59140 |
59150 |
59151 |
59350 |
59514 |
59525 |
59620 |
59866 |
59870 |
59898 |
59899 |
|
|
|
Endocrine System
60200 |
60210 |
60212 |
60220 |
60225 |
60240 |
60252 |
60254 |
60260 |
60270 |
60271 |
60280 |
60281 |
60500 |
60502 |
60505 |
60512 |
60520 |
60521 |
60522 |
60540 |
60545 |
60600 |
60605 |
60650 |
60659 |
60699 |
G0342 |
G0343 |
|
|
|
|
|
|
Nervous System
61140 |
61154 |
61156 |
61250 |
61253 |
61304 |
61305 |
61312 |
61313 |
61314 |
61315 |
61320 |
61321 |
61322 |
61323 |
61330 |
61333 |
61340 |
61343 |
61345 |
61450 |
61458 |
61460 |
61500 |
61501 |
61510 |
61512 |
61514 |
61516 |
61518 |
61519 |
61520 |
61521 |
61522 |
61524 |
61531 |
61533 |
61534 |
61535 |
61536 |
61537 |
61538 |
61539 |
61540 |
61541 |
61543 |
61544 |
61545 |
61546 |
61548 |
61550 |
61552 |
61556 |
61557 |
61558 |
61559 |
61563 |
61564 |
61566 |
61567 |
61570 |
61571 |
61575 |
61576 |
61582 |
61583 |
61584 |
61585 |
61586 |
61590 |
61591 |
61592 |
61596 |
61597 |
61598 |
61600 |
61601 |
61605 |
61606 |
61607 |
61608 |
61611 |
61613 |
61615 |
61616 |
61618 |
61619 |
61630 |
61635 |
61680 |
61682 |
61684 |
61686 |
61690 |
61692 |
61697 |
61698 |
61700 |
61702 |
61703 |
61705 |
61708 |
61711 |
61796 |
61797 |
61798 |
61799 |
61800 |
61850 |
61860 |
61863 |
61864 |
61867 |
61868 |
61880 |
62005 |
62010 |
62100 |
62115 |
62117 |
62120 |
62121 |
62140 |
62141 |
62142 |
62143 |
62145 |
62146 |
62147 |
62161 |
62162 |
62164 |
62180 |
62192 |
62200 |
62220 |
62223 |
62230 |
62256 |
62258 |
62351 |
62380 |
63001 |
63003 |
63005 |
63011 |
63012 |
63015 |
63016 |
63017 |
63020 |
63030 |
63035 |
63040 |
63042 |
63043 |
63044 |
63045 |
63046 |
63047 |
63048 |
63050 |
63051 |
63055 |
63056 |
63057 |
63064 |
63066 |
63075 |
63076 |
63077 |
63078 |
63081 |
63082 |
63085 |
63086 |
63087 |
63088 |
63090 |
63091 |
63101 |
63102 |
63103 |
63170 |
63172 |
63173 |
63185 |
63190 |
63191 |
63194 |
63195 |
63196 |
63197 |
63198 |
63199 |
63200 |
63250 |
63251 |
63252 |
63265 |
63266 |
63267 |
63268 |
63270 |
63271 |
63272 |
63273 |
63275 |
63276 |
63277 |
63278 |
63280 |
63281 |
63282 |
63283 |
63285 |
63286 |
63287 |
63290 |
63295 |
63300 |
63301 |
63302 |
63303 |
63304 |
63305 |
63306 |
63307 |
63308 |
63620 |
63621 |
63655 |
63661 |
63662 |
63663 |
63664 |
63685 |
63700 |
63702 |
63704 |
63706 |
63707 |
63709 |
63710 |
63740 |
63741 |
63744 |
64490 |
64491 |
64492 |
64493 |
64494 |
64495 |
64580 |
64704 |
64708 |
64712 |
64713 |
64714 |
64716 |
64722 |
64732 |
64736 |
64738 |
64740 |
64742 |
64746 |
64755 |
64760 |
64763 |
64766 |
64771 |
64772 |
64786 |
64792 |
64802 |
64804 |
64809 |
64818 |
64835 |
64836 |
64837 |
64840 |
64857 |
64858 |
64859 |
64861 |
64862 |
64864 |
64865 |
64866 |
64868 |
64872 |
64874 |
64876 |
64885 |
64886 |
64890 |
64891 |
64892 |
64893 |
64895 |
64896 |
64897 |
64898 |
64901 |
64902 |
64905 |
64907 |
64910 |
64911 |
64912 |
64913 |
|
|
Eye and Ocular Adnexa
65105 |
65110 |
65112 |
65114 |
65260 |
65265 |
65710 |
65730 |
65750 |
65755 |
65756 |
65770 |
65781 |
65900 |
66170 |
66172 |
66174 |
66175 |
66179 |
66180 |
66183 |
66184 |
66185 |
67027 |
67036 |
67039 |
67040 |
67041 |
67042 |
67043 |
67107 |
67108 |
67113 |
67121 |
67255 |
67340 |
67399 |
67413 |
67414 |
67420 |
67430 |
67440 |
67445 |
67450 |
67570 |
67599 |
67973 |
67974 |
68720 |
68745 |
68750 |
|
|
|
|
|
Auditory System
69155 |
69320 |
69530 |
69550 |
69552 |
69554 |
69670 |
69711 |
69725 |
69740 |
69745 |
69805 |
69915 |
69950 |
69955 |
69960 |
69970 |
69990 |
|
|
|
Refer to Medical Policy, S-112 Co-Surgery, for additional information.
Refer to Medical Policy, S-12 Team Surgery, for additional information.
Refer to Medical Policy, S-100 Multiple Surgical Procedures, for additional information.
Refer to Highmark Reimbursement Policy Bulletin, RP-001 Assistant at Surgery Services, for additional information on reimbursement coverage.
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical or other circumstances may warrant individual consideration, based on review of applicable medical records, as well as other regulatory, contractual and/or legal requirements.
Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract, and subject to the applicable laws of your state.
Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.
Discrimination is Against the Law
The Claims Administrator/Insurer complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Claims Administrator/Insurer does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The Claims Administrator/ Insurer:
If you need these services, contact the Civil Rights Coordinator.
If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. Box 22492, Pittsburgh, PA 15222, Phone: 1-866-286-8295, TTY: 711, Fax: 412-544-2475, email: CivilRightsCoordinator@highmarkhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Insurance or benefit/claims administration may be provided by Highmark, Highmark Choice Company, Highmark Coverage Advantage, Highmark Health Insurance Company, First Priority Life Insurance Company, First Priority Health, Highmark Benefits Group, Highmark Select Resources, Highmark Senior Solutions Company or Highmark Senior Health Company, all of which are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.
Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.
Discrimination is Against the Law
The Claims Administrator/Insurer complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Claims Administrator/Insurer does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The Claims Administrator/ Insurer:
If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. Box 22492, Pittsburgh, PA 15222, Phone: 1-866-286-8295, TTY: 711, Fax: 412-544-2475, email: CivilRightsCoordinator@highmarkhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
