CMS Pub. 100-04, ch. 4, § 250.9.4

Hospital

(Rev. 1620; Issued: 10-24-08; Effective: 01-01-08; Implementation: 04-06-09)

Section 1842(b)(7)(D) stipulates that no payment shall be made for the services of

assistant at surgery with respect to a surgical procedure if a hospital has a training

program relating to the medical specialty required for the surgical procedure and a

qualified individual on the staff of the hospital is available to provide such services.

A/B MACs (A) process assistant at surgery claims for services furnished in a teaching

hospital through the use of modifier 82 which indicates that a qualified resident was not

available. Modifier 82 is for use only when the basis for payment is the unavailability of

qualified residents.

Payment may be made for the services of assistants at surgery in teaching hospitals not

withstanding the availability of a qualified resident to furnish the services. There may be

exceptional medical circumstances (emergency, life threatening situations such as

multiple traumatic injuries) which require immediate treatment. There may be situations

in which the medical staff may find that exceptional medical circumstances justify the

services of a physician assistant at surgery even though a qualified resident is available.

Payment may also be made for the services of assistants at surgery in teaching hospitals,

if the primary surgeon has an across-the-board policy of never involving residents in the

preoperative, operative, or postoperative care of his or her patients.

Claims submitted by a Method II CAH teaching hospital on type of bill 85X with RC

96X, 97X or 98X and modifier AS, 80 or 81 are suspended for review by the A/B MAC

(A) when the HCPCS/CPT code has a payment policy indicator of ‘0’ or ‘2’.

NOTE: Teaching hospitals are identified by an intern to bed ratio greater than 0

(zero), this field is located on the Provider Specific File.